PsychologicalDisorders

Aguilar.Decimar.Viaa

Statistics:
USA 44millionAmericanseachyearsufferfromapsychologicaldisorder Outof20,000individualsintheUSA: 32%hadexperiencedapsychologicaldisorderintheirlifetime 20%currentlyhadanactivedisorder 17%hadasubstanceabusedisorder Philippines In88millionFilipinos,880,000areexpectedtobeschizophrenic NSOSurvey(2000) Mental illness 3rd most common form of disability after visual and hearing disabilities Averageof88reportedcasesofmentalillnessper100,000Filipinos 0.7% of the total household in the Philippines during the year, 2004, have a memberwithmentaldisability three primaryhealthcentersin Manila,oneoutof 5adultsand oneoutof10 childrenages5to15consultingtothesecentershavementaldisorders

Commonmisconceptions
MYTH:Abnormalbehaviorisalwaysbizarre. FACT: The behavior of many people who are diagnosed as having a mental disorder often cannot be distinguishedfromthatofnormalpeople MYTH:Normalandabnormalbehavioraredifferentinkind FACT: Few, if any types, of behavior displayed by people with a mental disorder often cannot be distinguished from that of normal people. Abnormal behavior consists of a poor fit between the behaviorandthesituationinwhichitisenacted. MYTH:Oncepeoplehaveamentaldisorder,theywillalwayshaveit. FACT:Mostpeoplecanbesuccessfullytreatedforamentaldisorder.

AbnormalBehaviorDefined
Insanity legal term referring to an inability to appreciate the nature and quality or wrongfulness of onesacts 1

Abnormalbehavior Amentalillnessthataffectsorismanifestedinapersonsbrainandcanaffectthewaya personthinks(APA) Behaviorthatisdeviant(atypicalbehaviorwhichdeviatesfromwhatisacceptableina culture), maladaptive (behavior which interferes with a persons ability to function effectively in the world), or personally distressful. Only one of the three criteria is neededforabehaviortobeclassifiedasabnormalbehavior.

TheoreticalApproachestoPsychologicalDisorders
1.BiologicalApproach Medicalmodel(psychologicaldisordersasmedicaldiseaseswithabiologicalorigin. Brainandgenetics Mentalillnessesabnormalities,patientsafflictedindividuals,doctors Drugtherapyfrequentlyusedtotreatdisorders Structuralviewsabnormalitiesinthebrainstructure Biochemicalviewsimbalancesinneurotransmittersorhormones Geneticviewsdisorderedgenes 2.PsychologicalApproach Psychodynamic perspective unconscious conflicts that produce anxiety and result in maladaptive behavior. Behavioralandsocialcognitiveperspective Behavioralrewardsandpunishmentsintheenvironment Socialcognitiveobservationallearning,expectancies,selfefficacy,selfcontrol,beliefabout oneselfandtheworld Humanisticperspective capacityforgrowth,freedomtochooseonesowndestiny,andpositivepersonalqualities Psychologicaldisorderinabilitytofulfillonespotentialarisingfromsocietalpressures Personwithadisorderlowselfconcept 3.SocioculturalApproach Environmentalexperiences Emphasisonlargersocialconceptsinwhichapersonlives Marriageorfamily,neighborhood,socioeconomicstatus,ethnicity,gender,orculture Individualsfromlowincome,minorityneighborhoodshighestrateofmentaldisorders Socioeconomicstatusstrongerrolethanethnicity

Gender (woman are more likely to suffer from internalized disorders while men from externalizeddisorders) Culturerelateddisorders(amok,anorexia,windigo)

ClassifyingAbnormalBehavior
Advantages Providesabasisforcommunicating Helpscliniciansmakepredictions

DSMIVClassificationSystem
DiagnosticandStatisticalManualofMentalDisorders,,fourthedition(1994) 1952,AmericanPsychiatricAssociation 17majorclassifications,200specificdisorders Multiaxialsystem Classifiesindividualsonthebasisoffivedimensions,oraxes,thattakeintoaccountthe individualshistoryandhighestleveloffunctioninginthepreviousyear Ensuresthatanindividualiscategorizedaccordingtoclinicalfactors

FiveaxesofDSMIV AxisI.Allpersonalitydisordersexceptpersonalitydisordersandmentalretardation AxisII.Personalitydisordersandmentalretardation. AxisIII.Generalmedicalconditions AxisIV.Psychosocialandenvironmentalproblems AxisV.Currentleveloffunctioning ControversiesandIssues: MorenonpsychiatriststhaneverwereresponsiblefordraftingtheDSMIV Labelsaspsychologicaldisorderswhatareoftenthoughtofaseverydayproblems The system focuses strictly on pathology and problems, with a bias toward finding somethingwrongwithanyonewhobecomestheobjectofdiagnosticstudy Labelscanbedamagingwhentheydrawattentiontooneaspectofapersonandignore others TextualrevisionsinDSMIVTR correctionoffactualerrorsinthetextofDSMIV reviewofcurrencyofinformationinDSMIV changes reflecting research published after 1992, which was the last year included in the literaturereviewpriortothepublicationofDSMIV ImprovementstoenhancetheeducationalvalueofDSMIV UpdatingofICDdiagnosticcodes,someofwhichwerechangedin1996 3

Changes in the criteria for several disorders: diagnosis of paraphilias (exhibitionism and voyeurism)

ANXIETYDISORDERS
Psychological disorders that feature motor tension (jumpiness, trembling, inability to relax), hyperactivity (dizziness, racing heart, or perspiration) and apprehensive expectations and thoughts 19.1millionor13.3%ofadultsfrom18to54arediagnosedwithanxietyperyear

GeneralAnxietyDisorder
Etiology BiologicalfactorsgeneticpredispositionandadeficiencyintheneurotransmitterGABA Psychologicalandsocioculturalfactors harshselfstandardsthatareimpossibletomaintain Verystrictandcriticalparents(lowselfesteem) Automaticnegativethoughtsinthefaceofstress Historyofuncontrollablestressorsortraumas Persistentanxietyforatleastonemonth Unabletospecifyreasonsfortheanxiety Nervousmostofthetimeandworriesaboutminorthings 4millionAmericansor2.8%ofadultsfrom18to54

PanicDisorder
Anxietydisordermarkedbyrecurrent,suddenonsetofintenseapprehensionorterror Feelingofimpendingdoombutmaynotgetanxiousallthetime Often strike without warning and produce severe palpitations, extreme shortness of breath, chestpains,trembling,dizziness,andafeelingofhelplessness Victimsseizedbyfearthattheywilldie,gocrazy,ordosomethingthattheycannotcontrol 2.4millionor1.7%ofadultsfrom18to54 Gowithorwithoutagarophobia(fearsofpublicplacesandinabilitytoescapeandfindhelp) Being in crowded places, traveling away from home, being separated from someone 2.5%ofindividualsintheUS Remainhomebound Etiology Stressfullifeevent6monthspriortothedisorder Agarophobiafearoffearhypothesis Gendersocializationandtraumaticexperiences 4

Biological overreactiontolacticacidwhenstressed Genetic Overlyactiveautonomicnervoussystem Hyperventilationoroverbreathing ProblemsinvolvingnorepinephrineorGABA

PhobicDisorder
Irrational,overwhelming,persistentfearofaparticularobjectorsituation Canpinpointthecauseofanxiety 6.3millionsor4.4%ofadults Socialphobia Intensefearofbeingembarrassedinsocialsituations Avoid speaking up in a conversation, giving a speech, going out to eat, or attending a party Etiology Genetic Thalamus,amygdala,andcerebralcortexneuralcircuit Serotonin Defensemechanismtowardoffthreateningorunacceptableimpulses Learnedfears ananxietydisorderinwhichtheindividualhasanxietyprovokingthoughtsthatwillnotgoaway and/orurgestoperformrepetitiveritualisticbehaviors topreventorproducesomefuturesituation Obsessionideas,imagesandimpulsesthatrunthroughtheperson'smindoverandoveragain Fearofdirt/germs Disgustofbodilywaste/fluids Concernwithsymmetry/balance Compulsion behaviors according to certain rules in order to alleviate the feeling of obsession Cleaningandgrooming,suchaswashinghands,showeringorbrushingteeth overandoveragain Checkingdrawers,doorlocksandappliancestobesuretheyareshut,locked orturnedoff Repeating actions, such as going in and out of a door, sitting down and gettingupfromachair,ortouchingcertainobjectsseveraltimes 5

ObsessiveCompulsiveDisorder(OCD)

EtiologyofOCD Biological Geneticcomponent,hereditary Brainimaging studies frontal cortex or basal ganglia are so active in OCD that numerous impulses reach the thalamus, generatingobsessivethoughtsorcompulsiveactions. DepletionofSerotonin

PostTraumaticStressDisorder(PTSD)
Psychological disorder that develop through exposure to a traumatic event, such as war; severely oppressive situations, such as Holocaust; severe abuse, as in rape; natural disasters, suchasfloodsandtornadoes;andunnaturaldisasters,likeplanecrashes SYMPTOMS

Flashbacks Constrictedabilitytofeelemotions Excessivearousal Difficultieswithmemoryandconcentration Feelingsofapprehensions,includingnervoustremors Impulsiveoutburstsofbehavior

DISSOCIATIVEDISORDERS
Dissociative Amnesia characterized by extreme memory loss that is caused by extensive psychologicalstress. Dissociative Fugue the individual not only develops amnesia but also unexpectedly travels awayfromhomeandassumesanewidentity DissociativeIdentityDisorder Multiplepersonalitydisorder Probablythemostdramaticbutleastcommondissociativedisorder IndividualssufferingfromDIDhavetwoormoredistinctpersonalitiesorselves Eachpersonalityhasitsownmemories,behaviors,andrelationships Onepersonalitydominatesatonetime;andanothertakesoveratanothertime. Shiftsusuallyoccurunderdistress 6 Involveasuddenlossofmemoryorchangeinidentity Dissociatedseparatedorsplit Difficultyinintegratingtheactiveandpassivedimensionsofconsciousness

CausesandEffects Inordinatelyhighrateofsexualorphysicalabuseduringearlychildhood Mostlyadultfemaleshavethisdisorder Whenmalesdevelopthisdisorder,theyshowmoreaggressionthanfemales

MOODDISORDERS
Majordepressivedisorder Individuals experience a major depressive episode and depressed characteristics,suchaslethargyandhopelessness,foratleast2weeks Dailyfunctioningbecomesimpaired Symptoms Depressedmoodmostoftheday Reducedinterestorpleasureinallormostactivities Significantweightlossorgain Troublesleepingoroversleeping Psychomotoragitationorretardation Fatigue Feelingofworthlessness Problemsinthinking,concentrating,ormakingdecisions Recurrentthoughtsofdeathandsuicide DysthymicDisorder MorechronicandhasfewersymptomsthanMDD. The individual is in a depressed mood for most days for at least 2 years as an adultoratleast1yearasachildoradolescent Amajordepressiveepisodemustnothaveoccurred,andthe2yeardepression mustnothavebeenbrokenbyanormalmoodlastingmorethat2months Twoormoreofthesesymptomsmustbepresent: Poorappetiteorovereating Sleepproblems 7 CLASSIFICATIONS Disordersinwhichthereisaprimarydisturbanceofmood(prolongedemotionthatcolorsthe individual'sentireemotionalstate) Includecognitive,behavioral,andsomaticsymptoms,aswellasinterpersonaldifficulties Depressive Disorder mood disorder in which the individual suffers depression without ever experiencingmania(stateofabnormalarousal)

Lowenergy Lowselfesteem Poorconcentrationordifficultyinmakingdecisions Feelingofhopelessness

BipolarDisorder Is a mood disorder that is characterized by extreme mood swings that include oneormoreepisodesofmania(anoverexcited,unrealisticallyoptimisticstate) Bipolarexperienceofbothdepressionandmania DepressiveEpisode ManicEpisodeapersonfeelseuphoricandontopoftheworld.Astheepisode unfolds,onecanexperiencepanicandeventuallyfallintodepression

CausesofMoodDisorders Biologicalfactors Heredity Depressiveandbipolardisorderstendtoruninfamilies And individual with an identical twin who has bipolar disorder has more than 60% chanceofhavingthesamedisorder Recent studies suggest that chromosome 22 may be the genetic location of Bipolar disorder NeurobiologicalAbnormalities Alteredbrainwaveactivitiesduringsleep Individuals with disorders tend to experience less slowwave sleep and go into REMsleepearlierinthenightthannondepressedindividuals Neuroimaging studies decreased metabolic activity in the cerebral cortex of thosewithsevermajordepressivedisorder Neurondeathanddisability Hormones slowchronichyperactivityintheneuroendocrineglandularsystem women's increased vulnerability to depression is linked to their ovarian hormones,estrogenandprogesterone PsychologicalFactors PsychodynamicExplanations Depression stems from an individuals' childhood experiences that prevented themfromdevelopingastrongpositivesenseofself Freud'stheorydepressionisaturninginwardofaggressiveinstincts LoveobjectLoveandhate 8

BehavioralExplanations reduction of positive reinforcers in a person's life leads to depression (Lewinsohn&Gottlib) stress>withdrawal>reductionofpositivereinforcers>furtherwithdrawal> furtherpositivereinforcersreduction learnedhelplessness inability to avoid aversive stimulation produces an apathetic state of helplessness. whenindividualscannotcopewiththestresstheyencounter,theyfeelhelpless anddepressed.(Seligman,Martin,1975) ruminativecopingstyle(SusanNolenHoeksema)individualsfocusintentlyon how they feel but do not try to do anything about the feelings. They just ruminateabouttheirdepression. Recommended:actionorientedcopingstyle CognitiveExplanations depressedindividualsrarelythinkofpositivethoughts. negativeexpectationsaboutthefuture negative thoughts reflect schemas that shape the depressed individual's experiences(Gilbert,2001) Catastrophicthinkingactionsleadtonegativeresultssuchasfailure,etc. CognitiveDistortions AllornothingThinking Overgeneralization MentalFilter Disqualifyingthepositive Jumpingtoconclusions MagnificationorMinimization EmotionalReasoning Shouldstatements Labelingandmislabeling Personalization SocioculturalFactors Interpersonalrelationship Oneviewofdepressionisthatitmaystemfromproblemsthatdevelopin relationshipswithotherpeople. Socioeconomicandethicvariations Individualswithalowsocioeconomicstatus(SES);especiallythoselivingin poverty,aremorelikelytodevelopdepressionthantheirhigherSES counterparts. Culturalvariations 9

Depressivedisordersarefoundinvirtuallyallculturesintheworld,buttheir incidence,intensity,andcomponentsvaryacrosscultures. Gender Bipolardisorderoccursaboutequallyamongwomenandmen,butwomen areabouttwiceaslikelyasmentodevelopdepression.

Suicide
Severedepressionandotherpsychologicaldisorderscancauseindividualstowanttoendtheir lives.Isabnormalbehavior,itisnotuncommonforindividualstocontemplatesuicideatsome pointintheirlives

BiologicalFactors Geneticfactorsappeartoplayaroleinsuicide,whichtendstoruninfamilies. Anumberofstudieshavelinkedwithlowlevelsoftheneurotransmitterserotonin. Individualswhoattemptsuicideandwhohavelowlevelsofserotoninare10timeslikelierto attemptsuicideagainthanarethoseattempterswhohavehighlevelsofserotonin. Anotherriskfactorforsuicideisthepoorphysicalhealth,especiallywhenitislongstandingand chronic.

Psychologicalfactors Cancontributetosuicideincludementaldisordersandtraumas,suchassexualabuse. Themostcommonmentaldisorderamongindividualswhocommitsuicideisdepression.

SocioculturalFactors Thelossoflovedonethroughdeath,divorce,orseparationcanleadtoasuicideattempt.

SCHIZOPHRENIA
Aseverepsychologicaldisorderthatischaracterizedbyhighlydisorderedthoughtprocesses.

TypesofSchizophrenia Disorganizedschizophrenia 10 Anindividualhasdelusionsandhallucinationsthathavelittleornorecognizablemeaning.

CatatonicSchizophrenia Ischaracterizedbybizarremotorbehavior,whichsometimestakestheformofacompletely immobilestupor.

ParanoidSchizophrenia Ischaracterizedbydelusionsofreference,grandeur,andpersecution. Delusionsusuallyformanelaboratesystembasedonacompletemisinterpretationofevents.

Threeunusualdevelopmentsinschizophreniadelusions 1.Theysensethattheyarespecialandmisinterpretchanceeventsasbeingdirectlyrelevanttotheir ownlives. 2.Theybelievethatthisspecialattentionistheresultoftheirspecialcharacteristics. 3.Theythinkthatothersaresojealousandthreatenedbythesecharacteristicsthattheyspyand plotagainstthem. Undifferentiatedschizophrenia Ischaracterizedbydisorganizedbehavior,hallucinations,delusions,andincoherence. Diagnosisisusedwhenanindividualssymptomseitherdonotmeetthecriteriaforoneofthe othertypesormeetthecriteriaformorethanoneoftheothertypes.

Causesofschizophrenia BiologicalFactors Compellingistheevidenceforageneticpredisposition,butstructuralabnormalitiesand neurotransmittersalsoseemtobelinkedtothisdevastatingdisorder. Heredityifyouhavearelativewithschizophrenia. StructuralBrainAbnormalitiesinthebrainhavebeenfoundinindividualswithschizophrenia. Imagingtechniques,suchasthePETscan,clearlyshowenlargedventriclesinthebrainsofthese people.Ventriclesarefluidfilledspacesinthebrain,andenlargementoftheventriclesindicates atrophy,ordeterioration,inotherbraintissue. NeurotransmitterDeregulationanearlybiologicalexplanationforschizophreniastatedthat individualswithschizophreniaproducehigherthannormallevelsoftheneurotransmitter dopamineandthattheexcessdopaminecausesschizophrenia.

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PsychologicalFactors Stressmaybeacontributingfactor. Thediathesisstressmodelarguesthatacombinationofbiogeneticdispositionandstresscauses schizophrenia. Diathesismeanspsychologicalvulnerabilityorpredispositiontoaparticulardisorder.

SocioculuturalFactors Thetypeandincidenceofschizophreniadisordersmayvaryfromculturetoculture. Individualslivinginpovertyarelikeliertohaveschizophreniathanpeopleathigher socioeconomiclevels.

PERSONALITYDISORDERS
Arechronic,maladaptivecognitivebehavioralpatternsthatarethoroughlyintegratedintothe individual'spersonality. Arenotasbizarreasschizophrenia,andtheydonothavetheintense,diffusefeelingsoffearand apprehensionthatcharacterizedtheanxietydisorders. ThreeClustersofPersonalitydisorder 1. Odd/EccentricCluster Paranoid Theseindividualshavealackoftrustinothersandaresuspicious.

Schizoid Theydonotformadequatesocialrelationships.

Schizotypal Theyshowoddthinkingpatternsthatreflecteccentricbeliefs,overtsuspicion,andovert suspicion,andoverthostility.

2. Dramatic/EmotionallyProblematicCluster Histrionic Theseindividualsseekalotofattentionandtendtooverreact. 12

Narcissistic Theyhaveanunrealisticsenseofselfimportance,canttakecriticism,manipulatepeople,andlack empathy. Borderline Theseindividualsareoftenemotionallyunstable,impulsive,unpredictable,irritable,and anxious.

Antisocial Theyareguiltless,lawbreaking,exploitive,selfindulgent,irresponsible,andintrusive. Thecausesofantisocialpersonalitydisorder Biologicalfactor Ageneticpredispositionforthedisordermaybepresent. PsychologicalFactor Theimpulsiveandaggressivebehaviorthatcharacterizesindividualswithantisocialpersonality disorderssuggeststhattheyhavenotadequatelylearnedhowtodelaygratification. ocioculturalFactor Inadequatesocializationregularlyappearsinthehistoryofindividualswhodevelopantisocial personalitydisorder.

3. ChronicFearfulness/AvoidantCluster Avoidant Theseindividualsareshyandinhibitedyetdesireinterpersonalrelationships,which distinguishesthemfromtheschizoidandschizotypaldisorders. Theyoftenhavelowselfesteemandareextremelysensitivetorejection. Thisdisorderclosetobeingananxietydisorderbutisnotcharacterizedbyasmuchpersonal distress.

Dependent Theylackselfconfidenceanddonotexpresstheirownpersonalities. Theyhaveapassiveneedtoclingtostrongerpersonalities,whomtheyallowtomakedecisions forthem. Thedisorderisfarmorecommoninwomenthaninmen. 13

Passiveaggressive Theseindividualsoftenpoutandprocrastinate;Theyarebornorareintentionallyinefficientin anefforttofrustrateothers.

Obsessivecompulsive Thepersonalitydisorderisoftenconfusedwithobsessivecompulsiveanxietydisorder. However,anindividualwithobsessivecompulsivepersonalitydisorderrarelybecomesobsessed aboutissues. Inpersonalitydisorder,thepersondoesnotbecomeupsetordistressedabouthisorher lifestyle.Theseindividualsareobsessedwithrules,areemotionallyintensive,andareoriented towardalifestyleofproductivityandefficiency.

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