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11/25/13!

Psychological Disorders
Dr. L. Kevin Chapman Psychology 201 Chapter 14

Psychological Disorders
•" Definition and Prevalence •" Anxiety Disorders: Description & Causes
–" Treatments for Anxiety Disorders
•" Biological •" Behavioral

•" Mood Disorders: Description & Causes
–" Treatments for Mood Disorders
•" Biological •" Behavioral

•" Examples throughout

Psychological Disorders
•" How are psychological disorders defined?
–" Specific criteria –" DSM-V (May 2013)

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population: Lifetime and Past Year –" Rates of Treatment Seeking 2! .11/25/13! Figure 14.S. 1994) •" NCS Revised (2005) –" Prevalence of Psychological Disorders in sample of people representative of the general U. Fourth Edition Copyright © 2005 by Worth Publishers Psychological Disorders •" How are psychological disorders defined? –" Personal distress –" Impairment in functioning Psychological Disorders •" The National Comorbidity Study (Kessler et al.1 Sample DSM-IV-TR Diagnostic Criteria Hockenbury: Psychology..

11/25/13! National Comorbidity Survey Replication Results •" Approximately 46% of adults experienced a psychological disorder at least once in their lives •" About 26% of people experienced a psychological disorder in the past year •" Approximately 59% who experienced symptoms in the last year did NOT seek treatment •" NCS-R -! Age of Onset and! Lifetime Prevalence of ! Mental Disorders! •" •" National Comorbidity Survey Replication (NCS-R): One out of four respondents (26 percent) reported experiencing symptoms of a psychological disorder during previous year NCS-R found one out of two adults (46 percent) experienced symptoms of a psychological disorder at some point in lives Different categories of mental disorders vary significantly in the median age of onset •" •" •" NCS-R found that most people with the symptoms of a mental disorder (59 percent) received no treatment during the past year Approximately 80 percent who experienced symptoms in the last year did not seek treatment Most people seem to deal with symptoms without complete debilitation Clicker Q next Anxiety: What is it? How Does It Differ From Fear? FEAR •"An “emotion alarm” responding to a present danger •"“True” alarm •"Specific. or focal •"Adaptive •"Example: Angry Dog ANXIETY •"“False” alarm responding to possible danger •"Vague feeling of “anticipatory apprehension” •"Primes the pump for “fear” •"Can be maladaptive •"Example: Angry Dog 3! .

” catastrophic thoughts Subjective (e. becomes a problem/disorder when it is irrational. uncontrollable.. and disruptive •" Worry is in response to anxiety –" An attempt to cope (often futile) •" Putting anxiety in to words: “I don’t know if this event will happen again. when one source of worry is removed. and genetic factors. global.11/25/13! Anxiety •" •" •" •" •" Cognitive: thoughts of “what if. psychological. are probably involved in GAD •"Problematic anxiety can be evident from a very early age •"Early stressful experiences may contribute 4! . and persistent symptoms of anxiety. another moves in to take its place •"Environmental. feelings of fear and apprehension) Physiological Behavioral: Maladaptive behaviors to reduce anxiety Everyone experiences it. but I have to be prepared just in case!” Types of Anxiety Disorders –" Most common diagnosed disorders throughout the US (18% of the population) –" Types of Anxiety Disorders •" Generalized Anxiety Disorder •" Panic Disorder (with or without Agoraphobia) •" Phobias •" Posttraumatic Stress Disorder (PTSD) •" Obsessive-Compulsive Disorder (OCD) ***Please note that anxiety runs in families*** •" Children of anxious parents are 4-7 times more likely than children of non-anxious parents to develop an anxiety disorder Generalized Anxiety Disorder" Worrying About Anything and Everything! Explaining Generalized Anxiety Disorder (GAD) •" Anxiety disorder characterized by excessive. also called free-floating anxiety •" In generalized anxiety disorder.g. as well as other biological factors.

etc –" Client examples •" Case example 5! . high physiological arousal •" Very frightening . malls.sufferers live in fear of having them •" Agoraphobia often develops as a result Agoraphobia •" Anxiety about places where panic may occur and escape is “difficult” –" Afraid that help won’t be available if one panics –" Crowds.11/25/13! Panic Attacks and Panic Disorders! Sudden Episodes of Extreme Anxiety! Pounding heart Rapid breathing Breathlessness Choking sensation Panic attack Sudden episode of extreme anxiety that rapidly escalates in intensity Symptoms: Sweating. elevators. and experiencing light-headedness Chills or hot flashes Escalating surge of physical arousal Feelings of terror and belief that one is about to die. or lose control Panic Disorder Typically peaks within 10 An anxiety disorder which minutes of onset and in then the person experiences gradually subsides frequent and unexpected panic attacks •" •" •" •" Frequency of panic attacks is highly variable and quite unpredictable Very frightening—sufferers live in fear of having them Agoraphobia often develops as a result gradually subsides Panic Disorder •" Panic attacks .helpless terror. supermarkets. go crazy. trembling.

intense.11/25/13! Explaining Panic Disorder! Barlow: Triple vulnerabilities model of panic based on combination of •"Biological predisposition toward anxiety •"Low sense of control over potentially life-threatening events •"Oversensitivity to physical sensations Catastrophic cognitions theory People with panic disorder are not only oversensitive to physical sensations— they also tend to catastrophize meaning of their experience The Phobias! Fear and Loathing! Phobia Persistent and irrational fear of a specific object. situation. situation. or activity Specific Phobia Excessive. or activity that is actively avoided or endured with marked anxiety •" Encountering feared situation or object can provoke a full-fledged panic attack •" About 13 percent of the general population experiences a specific phobia •" More than twice as many women as men suffer from specific phobia Four Primary Categories of Specific Phobias! Fear of particular situations Fear of features of the natural environment Fear of injury or blood Fear of animals and insects Most Common Phobias: 1)" Animals 2)" Heights 3)" Flying 4)" Blood/Injection 6! . and irrational fear of a specific object.

may represent a fear of contamination: spoiled foods. have an evolutionary history.11/25/13! Explaining Phobias! Learning Theories: Di#erent pathways ! Biological Preparation – certain fears. parasites Classical Conditioning as seen in the Watson and Rayner demonstration with Little Albert Operant Conditioning we are rewarded by reducing our conditioned fear by avoidance of the conditioned stimulus. infection. an example of negative reinforcement Observational Learning we model and imitate the fears we see in others Specific Phobia: Pathways Phobia Clip http://vimeo.com/38121852 (Begin at 14:00) 7! . such as to spiders or heights.

11/25/13! Behavioral Treatments: Exposure •" Gold standard treatment for phobias •" Exposure important for treatment of ALL anxiety disorders •" Systematic desensitization=type of Exposure –" train client in muscle relaxation –" then combine imagery of feared object with relaxation –" use increasingly frightening scenes –" Principle=counterconditioning: learn a new CR that inhibits old CR (i.. anxiety) •" Systematic Desensitization is NOT the most effective treatment for phobias today. •" SAD is far more debilitating than everyday shyness. can cause unbearable anxiety. •" Even ordinary activities.e. •" People with SAD are intensely fearful of being watched or judged by others. such as eating with friends in a shopping mall food court. •" Most common fear throughout the United States is (drumroll) Public Speaking 8! . •" Exposure and Cognitive work (explain in treatment section) Comparing Anxiety Disorders -–" Agoraphobia: Fear of panic attacks in places where help or escape options seem unavailable –" Social Anxiety Disorder (formerly social phobia): Fear of Social Situations –" Panic Disorder: “fear of fear” Social Anxiety Disorder •" About one out of eight adults in the United States have experienced social phobia at some point in their lives.

sleeplessness. anxiety. now in their eighties. nightmares.000 World War II veterans may continue to suffer from the symptoms of PTSD 9! . formal speaking.g. or assault •" Symptoms include: –" INTRUSIONS (e. rape.. group meetings.11/25/13! Anxiety Disorders: Social Anxiety Disorder •" Persistent fear of one or more social or performance situations •" Severe anxiety upon exposure to social situations where ridicule may occur –" Similar to panic attack •" Social situation avoided or endured with significant anxiety –" i..e. and other PTSD symptom •" Some experts estimate that as many as 200. class participation •" Case example Posttraumatic Stress Disorder (PTSD) •" Follows traumatic event or events such as war. easily startled. irritability) •" Causes PTSD •" The symptoms of posttraumatic stress disorder can apparently last a lifetime. still suffer from nightmares. flashbacks) –" AVOIDANCE –" HYPERAROUSAL (e.g. •" More than 60 years after the close of World War II thousands of veterans.

pathological doubt about having completed a task Compulsions Repetitive behaviors or mental acts that are performed to prevent or reduce anxiety May be overt or covert An anxiety disorder in which symptoms of anxiety are triggered by intrusive. and uncontrollable irrational thoughts or mental images that cause extreme anxiety and distress Common – fear of dirt. •" Often accompanied by an irrational belief that failure to perform ritual action will lead to catastrophe •" Usually both obsessions and compulsions are present and the sufferer can’t resist them even though they know they are absurd •" Content mirrors cultural beliefs •" United States – fear of germs •" India – concerns about religious purity OCD: Anxiety Disorder but not its own category •" OCD now its own category –" Obsessive Compulsive and Related Disorders along with: •" Hoarding Disorder •" Body Dysmorphic Disorder •" Excoriation Disorder (skin picking) •" Trichotillomania (“hair pulling” disorder) 10! .11/25/13! Obsessive–Compulsive Disorder" Checking It Again and Again! Obsessions Repeated. intrusive. repetitive thoughts and urges to perform certain actions. germs.

11/25/13! Explaining Obsessive– Compulsive Disorder" ! Deficiency in serotonin. norepinephrine implicated Drugs that increase the availability of these neurotransmitters decrease symptoms Dysfunction in specific brain areas Areas involved in the fight-orflight response Frontal lobes. which play a key role in our ability to think and plan ahead Heightened neural activity in caudate nucleus involved in regulating movements Excessive responsibility. guilt. certain intrusive thoughts are learned as unacceptable because they signal danger for which the person feels personally responsible! ! OCD Clip http://vimeo. and rigid codes of conduct may predispose someone to OCD! •" •" •" •" Generalized and specific psychological vulnerabilities ! May create thought-action fusion which is related to OCD symptoms! Intrusions produce distress when they have idiosyncratic meaning! So.com/53904764 (Stop at about 8 minutes) Mood Disorders (Affective Disorders) •" Major Depression •" Dysthymic Disorder 11! .

symptoms of major depression can easily last six months or longer More than half of all people who have been through one Symptoms tend episode of major Left untreated. long-term job. about 15 percent of Americans at some point in their lives •"Women are about twice as likely as men to be affected by major depression •"Women more vulnerable because •"Experience greater degree of chronic stress in daily life •"Have lesser sense of personal control •"More prone to dwell on their problems Situational Bases for Depression Positive correlation between stressful life events and onset of depression. Does life stress cause depression? Most life events that cause depression are losses (of a spouse or companion. to increase in depression may depression can severity and expect a relapse. but long-lasting depression –" lasts for at least 2 years •" Can have both at the same time •" Women diagnosed 2x as often as men The Prevalence of Major Depression •"6 percent to 7 percent of Americans are affected by major depression •"Lifetime prevalence. health. and physical symptoms of that disorder. cognitive. recur and time between usually within two become episodes years progressively decreases more severe The Symptoms of Major Depression The experience of major depression can permeate every aspect of life. or income) Course of Major Depression! Left untreated. This figure shows some of the most common emotional. 12! .11/25/13! Depression •" Major Depression –" More severe depression –" lasts without remission for at least 2 weeks •" Dysthymia –" less severe. behavioral.

11/25/13! Biological Bases for Depression •" Genetic vulnerability •" Neurotransmitter theories –" Low levels norepinephrine –" Low levels serotonin Can Depression be Treated? •" Most cases of depression can be effectively treated –" Antidepressants –" Cognitive-Behavioral Therapy –" Both 13! .