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Aguilar. Decimar. Viaña
• • USA 44 million Americans each year suffer from a psychological disorder Out of 20,000 individuals in the USA: • 32 % had experienced a psychological disorder in their lifetime • 20 % currently had an active disorder • 17 % had a substance abuse disorder Philippines • In 88 million Filipinos, 880,000 are expected to be schizophrenic • NSO Survey (2000) • Mental illness – 3rd most common form of disability after visual and hearing disabilities • Average of 88 reported cases of mental illness per 100,000 Filipinos • 0.7% of the total household in the Philippines during the year, 2004, have a member with mental disability • three primary health centers in Manila, one out of 5 adults and one out of 10 children ages 5 to 15 consulting to these centers have mental disorders
MYTH: Abnormal behavior is always bizarre. FACT: The behavior of many people who are diagnosed as having a mental disorder often cannot be distinguished from that of normal people MYTH: Normal and abnormal behavior are different in kind 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 behavior and the situation in which it is enacted. MYTH: Once people have a mental disorder, they will always have it. FACT: Most people can be successfully treated for a mental disorder.
Abnormal Behavior Defined
Insanity – legal term referring to an inability to appreciate the nature and quality or wrongfulness of one’s acts 1
Abnormal behavior • A mental illness that affects or is manifested in a person’s brain and can affect the way a person thinks (APA) • Behavior that is deviant (atypical behavior which deviates from what is acceptable in a culture), maladaptive (behavior which interferes with a person’s ability to function effectively in the world), or personally distressful. Only one of the three criteria is needed for a behavior to be classified as abnormal behavior.
Theoretical Approaches to Psychological Disorders
1. Biological Approach • Medical model (psychological disorders as medical diseases with a biological origin. • Brain and genetics • Mental illnesses ‐ abnormalities, patients ‐ afflicted individuals, doctors • Drug therapy frequently used to treat disorders Structural views – abnormalities in the brain structure Biochemical views – imbalances in neurotransmitters or hormones Genetic views – disordered genes 2. Psychological Approach Psychodynamic perspective – unconscious conflicts that produce anxiety and result in maladaptive behavior. Behavioral and social cognitive perspective Behavioral ‐ rewards and punishments in the environment Social cognitive ‐ observational learning, expectancies, self‐efficacy, self‐control, belief about oneself and the world Humanistic perspective • capacity for growth, freedom to choose one’s own destiny, and positive personal qualities • Psychological disorder ‐ inability to fulfill ones potential arising from societal pressures • Person with a disorder – low self‐concept 3. Sociocultural Approach • Environmental experiences • Emphasis on larger social concepts in which a person lives • Marriage or family, neighborhood, socio‐economic status, ethnicity, gender, or culture • Individuals from low income, minority neighborhoods – highest rate of mental disorders • Socioeconomic status stronger role than ethnicity
Gender (woman are more likely to suffer from internalized disorders while men from externalized disorders) Culture‐related disorders (amok, anorexia, windigo)
Classifying Abnormal Behavior
Advantages • Provides a basis for communicating • Helps clinicians make predictions
DSM‐IV Classification System
• Diagnostic and Statistical Manual of Mental Disorders,, fourth edition (1994) • 1952, American Psychiatric Association • 17 major classifications, 200 specific disorders Multiaxial system • Classifies individuals on the basis of five dimensions, or axes, that take into account the individual’s history and highest level of functioning in the previous year • Ensures that an individual is categorized according to clinical factors
Five axes of DSM‐IV • Axis I. All personality disorders except personality disorders and mental retardation • Axis II. Personality disorders and mental retardation. • Axis III. General medical conditions • Axis IV. Psychosocial and environmental problems • Axis V. Current level of functioning Controversies and Issues: • More non‐psychiatrists than ever were responsible for drafting the DSM‐IV • Labels as psychological disorders what are often thought of as everyday problems • The system focuses strictly on pathology and problems, with a bias toward finding something wrong with anyone who becomes the object of diagnostic study • Labels can be damaging when they draw attention to one aspect of a person and ignore others Textual revisions in DSM‐IV‐TR • correction of factual errors in the text of DSM‐IV • review of currency of information in DSM‐IV • changes reflecting research published after 1992, which was the last year included in the literature review prior to the publication of DSM‐IV • Improvements to enhance the educational value of DSM‐IV • Updating of ICD diagnostic codes, some of which were changed in 1996 3
Changes in the criteria for several disorders: diagnosis of paraphilias (exhibitionism and voyeurism)
• Psychological disorders that feature motor tension (jumpiness, trembling, inability to relax), hyperactivity (dizziness, racing heart, or perspiration) and apprehensive expectations and thoughts 19.1 million or 13.3% of adults from 18 to 54 are diagnosed with anxiety per year
General Anxiety Disorder
• • • • Etiology • Biological factors – genetic predisposition and a deficiency in the neurotransmitter GABA • Psychological and socio‐cultural factors • harsh self standards that are impossible to maintain • Very strict and critical parents (low self‐esteem) • Automatic negative thoughts in the face of stress • History of uncontrollable stressors or traumas Persistent anxiety for at least one month Unable to specify reasons for the anxiety Nervous most of the time and worries about minor things 4 million Americans or 2.8% of adults from 18 to 54
• • • • • • Anxiety disorder marked by recurrent, sudden onset of intense apprehension or terror Feeling of impending doom but may not get anxious all the time Often strike without warning and produce severe palpitations, extreme shortness of breath, chest pains, trembling, dizziness, and a feeling of helplessness Victims seized by fear that they will die, go crazy, or do something that they cannot control 2.4 million or 1.7 % of adults from 18 to 54 Go with or without agoraphobia (fears of public places and inability to escape and find help) • Being in crowded places, traveling away from home, being separated from someone • 2.5% of individuals in the US • Remain homebound Etiology • Stressful life event 6 months prior to the disorder • Agoraphobia – fear of fear hypothesis • Gender socialization and traumatic experiences 4
Biological • overreaction to lactic acid when stressed • Genetic • Overly active autonomic nervous system • Hyperventilation or over breathing • Problems involving norepinephrine or GABA
• • • • Irrational, overwhelming, persistent fear of a particular object or situation Can pinpoint the cause of anxiety 6.3 millions or 4.4% of adults Social phobia • Intense fear of being embarrassed in social situations • Avoid speaking up in a conversation, giving a speech, going out to eat, or attending a party Etiology • Genetic • Thalamus, amygdala, and cerebral cortex neural circuit • Serotonin • Defense mechanism to ward off threatening or unacceptable impulses • Learned fears an anxiety disorder in which the individual has anxiety‐provoking thoughts that will not go away and/or urges to perform repetitive ritualistic behaviors to prevent or produce some future situation Obsession – ideas, images and impulses that run through the person's mind over and over again Fear of dirt/germs Disgust of bodily waste/fluids Concern with symmetry/balance Compulsion – behaviors according to certain “rules” in order to alleviate the feeling of obsession Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again Checking drawers, door locks and appliances to be sure they are shut, locked or turned off Repeating actions, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times 5
Obsessive Compulsive Disorder (OCD)
Etiology of OCD Biological Genetic component, hereditary Brain‐imaging studies – frontal cortex or basal ganglia are so active in OCD that numerous impulses reach the thalamus, generating obsessive thoughts or compulsive actions. Depletion of Serotonin
Post‐Traumatic Stress Disorder (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, such as floods and tornadoes; and unnatural disasters, like plane crashes SYMPTOMS
Flashbacks Constricted ability to feel emotions Excessive arousal Difficulties with memory and concentration Feelings of apprehensions, including nervous tremors Impulsive outbursts of behavior
Dissociative Amnesia ‐ characterized by extreme memory loss that is caused by extensive psychological stress. Dissociative Fugue ‐ the individual not only develops amnesia but also unexpectedly travels away from home and assumes a new identity Dissociative Identity Disorder “Multiple personality disorder” Probably the most dramatic but least common dissociative disorder Individuals suffering from DID have two or more distinct personalities or selves Each personality has its own memories, behaviors, and relationships One personality dominates at one time; and another takes over at another time. Shifts usually occur under distress 6 Involve a sudden loss of memory or change in identity Dissociated – separated or split Difficulty in integrating the active and passive dimensions of consciousness
Causes and Effects Inordinately high rate of sexual or physical abuse during early childhood Mostly adult females have this disorder When males develop this disorder, they show more aggression than females
Major depressive disorder Individuals experience a major depressive episode and depressed characteristics, such as lethargy and hopelessness, for at least 2 weeks Daily functioning becomes impaired Symptoms Depressed mood most of the day Reduced interest or pleasure in all or most activities Significant weight loss or gain Trouble sleeping or oversleeping Psychomotor agitation or retardation Fatigue Feeling of worthlessness Problems in thinking, concentrating, or making decisions Recurrent thoughts of death and suicide Dysthymic Disorder More chronic and has fewer symptoms than MDD. The individual is in a depressed mood for most days for at least 2 years as an adult or at least 1 year as a child or adolescent A major depressive episode must not have occurred, and the 2 year depression must not have been broken by a normal mood lasting more that 2 months Two or more of these symptoms must be present: Poor appetite or overeating Sleep problems 7 CLASSIFICATIONS Disorders in which there is a primary disturbance of mood (prolonged emotion that colors the individual's entire emotional state) Include cognitive, behavioral, and somatic symptoms, as well as interpersonal difficulties Depressive Disorder – mood disorder in which the individual suffers depression without ever experiencing mania (state of abnormal arousal)
Low energy Low self‐esteem Poor concentration or difficulty in making decisions Feeling of hopelessness
Bipolar Disorder Is a mood disorder that is characterized by extreme mood swings that include one or more episodes of mania (an overexcited, unrealistically optimistic state) Bipolar – experience of both depression and mania Depressive Episode Manic Episode – a person feels euphoric and on top of the world. As the episode unfolds, one can experience panic and eventually fall into depression
Causes of Mood Disorders Biological factors Heredity Depressive and bipolar disorders tend to run in families And individual with an identical twin who has bipolar disorder has more than 60% chance of having the same disorder Recent studies suggest that chromosome 22 may be the genetic location of Bipolar disorder Neurobiological Abnormalities Altered brain‐wave activities during sleep Individuals with disorders tend to experience less slow‐wave sleep and go into REM sleep earlier in the night than non‐depressed individuals Neuroimaging studies – decreased metabolic activity in the cerebral cortex of those with sever major depressive disorder Neuron death and disability Hormones slow chronic hyperactivity in the neuroendocrine glandular system women's increased vulnerability to depression is linked to their ovarian hormones, estrogen and progesterone Psychological Factors Psychodynamic Explanations Depression stems from an individuals' childhood experiences that prevented them from developing a strong positive sense of self Freud's theory ‐ depression is a turning inward of aggressive instincts ‐ “Love object” ‐ Love and hate 8
Behavioral Explanations • reduction of positive reinforcers in a person's life leads to depression (Lewinsohn & Gottlib) • stress ‐> withdrawal ‐> reduction of positive reinforcers ‐> further withdrawal ‐> further positive reinforcers reduction • learned helplessness • inability to avoid aversive stimulation produces an apathetic state of helplessness. • when individuals cannot cope with the stress they encounter, they feel helpless and depressed.(Seligman, Martin , 1975) • ruminative coping style (Susan Nolen‐Hoeksema) ‐ individuals focus intently on how they feel but do not try to do anything about the feelings. They just ruminate about their depression. • Recommended: action‐oriented coping style Cognitive Explanations • depressed individuals rarely think of positive thoughts. • negative expectations about the future • negative thoughts reflect schemas that shape the depressed individual's experiences (Gilbert, 2001) • Catastrophic thinking ‐ actions lead to negative results such as failure, etc. • Cognitive Distortions • All‐or‐nothing Thinking • Overgeneralization • Mental Filter • Disqualifying the positive • Jumping to conclusions • Magnification or Minimization • Emotional Reasoning • Should statements • Labeling and mislabeling • Personalization
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