Overview of Anxiety, Somatoform, Dissociative & Personality Disorders, Study notes of Psychology

Download Overview of Anxiety, Somatoform, Dissociative & Personality Disorders and more Study notes Psychology in PDF only on Docsity! Chapter 12 The Psychological Disorders Outline I. What is “Abnormal”? A. Abnormal refers to maladaptive cognitions, affects, and/or behaviors that are at odds with social expectations and result in distress or discomfort. B. What may be abnormal and disordered in one culture or social situation may be viewed as normal and commonplace in another. II. Classifying Abnormal Reactions: The DSM A. Diagnosis is the act of recognizing a disorder on the basis of a specified set of symptoms. B. Emil Kraepelin published the first classification scheme for “mental disturbances” in 1883. C. The American Psychiatric Association published its system for classifying psychological disorders, The Diagnostic and Statistical Manual of Mental Disorders, in 1952. 1. The most recent edition, published in 2000, is the DSM-IV-TR (where TR stands for “text revision”). 2. The DSM-IV lists 297 different diagnostic categories. 3. Except for known biological factors, the manual attempts to avoid reference to etiology, or causes, of disorders. 4. The system is important for adequate communication concerning disorders. 5. Plans are now underway to publish a new DSM – the DSM-5 – in May of 2012 III. Problems with Classification and Labeling A. The DSM-IV refers only to disordered behaviors, not to disordered people. B. Labels do not explain behavior and may stick long after the symptoms are gone. C. Comorbidity refers to the occurrence of two or more disorders in the same individual. 1. For those suffering any disorder in his or her lifetime, nearly 80 percent will have two or more disorders. 2. Many psychological disorders are also comorbid with physical illnesses. IV. A Word on “Insanity” A. The term insanity is a legal term, not a psychological one. B. Insanity usually requires that one did not know or fully understand the consequences of his or her actions at a given time, could not discern the difference between right and wrong, and was unable to exercise control over his or her actions at the time a crime was committed. 1. Americans tend to over-estimate how often the insanity defense is used and how often it is successful. 2. It used in less than 1 percent of felony cases and is successful less than 20 percent of the time. C. A related issue, competence, concerns whether one is in control of his or her mental and intellectual functions to understand courtroom procedures and aid in his or her own defense. V. A Few Cautions A. “Abnormal” and “normal” are not two distinct categories. B. Abnormal does not mean dangerous. 1. People jailed for violent crimes are no more likely to have a psychological dosorder than not jailed persons. 2. Persons with psychological disorders are more likely than persons without such disorders to be victims of violent crimes. C. Abnormal does not mean bad. D. Psychological disorders may occur in mild and moderate forms. VI. Anxiety Disorders A. Anxiety refers to a feeling of general apprehension or dread accompanied by predictable physiological changes. 1. Anxiety disorders are the most common of all the psychological disorders, affecting 13.3 percent (19.1 million persons) in the U.S. aged 18-54. 2. They are diagnosed two to three times more in women than in men. 3. A 2010 study found anxiety disorders to be the most common of diagnoses in adolescents with a disorder. B. The major symptom of generalized anxiety disorder is distressing, felt anxiety. 1. Anxiety may be intense or diffuse, and can cause substantial interference. 2. A person with this diagnosis cannot attribute any particular source or cause of their experienced anxiety. 3. People with this disorder may be prone to drug and alcohol abuse. C. In panic disorder, the major symptom is more acute—a recurrent, unpredictable, unprovoked onset of sudden, intense anxiety, or a “panic attack.” 1. Onset is usually between adolescence and the mid-twenties. 2. A comorbid diagnosis of depression significantly increases the rate of suicide and suicide attempts. D. The essential feature of phobic disorders is a persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid that object, activity, or situation. 1. Specific phobias involve fear of animals; the physical environment; blood, injection or injury; or a specific situation. E. Cluster III: Disorders Involving Anxiety and Fearfulness 1. Avoidant personality disorder refers to an over-sensitivity to the possibility of being rejected by others and an unwillingness to enter into relationships for fear of being rejected. 2. Dependent personality disorder describes a person who allows and seeks others to dominate and assume responsibility for action; this person has a poor self-image and lacks confidence. F. The prognosis for the personality disorders is poor, but recent data points to several successful therapeutic interventions for many personality disorders.. G. The antisocial personality disorder is characterized by an exceptional lack of regard for the rights and property of others, accompanied by impulsive, often criminal behaviors. 1. Persons with the disorder used to be called “psychopaths” or “sociopaths.” 2. Symptoms include deceit and manipulation of others without guilt or regret. 3. The disorder is more common among persons of low socioeconomic status, who live in an urban setting and have a history of symptoms dating from childhood. 4. Although the disorder is very resistant to treatment, there is evidence of a burnout factor when these people reach their 40s. X. A Disorder of Childhood: Autism A. Autism is a disorder usually first diagnosed in childhood, characterized by impaired social interactions, problems with communication, and unusual or severely limited activities and interests. B. Once thought to be rare, it now afflicts as many as 1 of every 500 children. 1. It may afflict as many as 1 of every 100 children. 2. It is four times as common among boys as girls. C. There is no known cause for autism. D. There is no known cure, but there are interventions that can produce significant improvements in functioning. XI. A Disorder of Childhood: Attention-Deficit Hyperactivity Disorder (ADHD) A. Children with this disorder find it difficult to focus or attend to tasks that are repetitive or boring. B. The disorder is also characterized by impulsivity and hyperactivity. C. In the U.S. the prevalence of ADHD is estimated at about 7 percent of the population, affecting about 3 times as many boys as girls. D. The exact causes of this disorder are unknown, but there is agreement that there is a strong biological/genetic basis for ADHD. E. Treatment for attention-deficit hyperactivity disorder is two pronged: a) a medical approach (using stimulant drugs such as Ritalin, Adderall, or Concerta), and b) a psychological approach emphasizing the reinforcement and shaping of appropriate behaviors and helping parent learn effective means of dealing with the disruptive actions of the ADHD child. XII. Alzheimer’s Dementia A. Dementia is a condition characterized by the marked loss of intellectual abilities. B. A slow deterioration of one’s intellectual functioning is the most common symptom associated with Alzheimer’s disease; personality changes also occur. C. It is a physical disease caused by abnormal changes in brain tissue. D. It is diagnosed with certainty at autopsy. 1. There will be a mass of tangles of abnormal protein fibers. 2. Waste materials, called plaques, are degenerated nerve fibers that wrap around a core of protein. 3. There will be small cavities filled with fluid and debris. 4. Atrophy will be evident. 5. Recent evidence suggests that there may be significant early indicators of the disorder. E. Alzheimer’s dementia is becoming increasingly more common. 1. About 10 million in North America and Europe have been diagnosed. 2. In the year 2000 there were 4.5 million persons in the U. S. diagnosed with Alzheimer’s; by the year 2050, that number is estimated to be 65 million worldwide. F. There is a genetic predisposition for the disorder. 1. Obesity is a risk factor for developing Alzheimer’s dementia. 2. Receiving a head injury or trauma is a risk factor. 3. Using folic acid in one’s diet may reduce the chance of getting Alzheimer’s. 4. Engaging in cognitively challenging activities may reduce the risk of Alzheimer’s dementia in old age. G. A number of hypotheses are being investigated for the cause and treatment of the disorder. XIII. Mood Disorders A. With mood disorders, the intensity or extreme nature of one’s mood is the major symptom. B. Major depression is the diagnosis for a constellation of symptoms that includes feeling sad, low, and hopeless, coupled with a loss of pleasure or interest in most normal activities. C. Dysthymia is a mild case of major depression, but it tends to be more chronic, or continuous. D. In bipolar disorder, episodes of depression are occasionally interspersed with episodes of mania. !. This is still referred to as “manic depression.” 2. Mania is characterized as an elevated mood with feelings of euphoria or irritability and increased levels of activity. XIV. The Roots of Depression A. There is evidence for a genetic, or inherited, predisposition to the bipolar mood disorder. B. We suspect that there is a genetic basis for major depression as well. C. The diathesis-stress model proposes that the expression of disordered behaviors (particularly depression) results from the interaction of an inherited predisposition and the experience of stress or trauma. 1. Some neurotransmitters, collectively referred to as biogenic amines, appear to influence mood. 2. Brain anatomy appears to be different for some of the individual disorders. D. A variety of psychological factors may influence the development of depression. 1. These could include learning experiences, situational stress, and cognitive factors. 2. Freud believed that depression was a reflection of early childhood experiences that leads to anger directed inwardly. 3. Women are twice as likely than men to be diagnosed with mood disorders. XV. Schizophrenia A. Schizophrenia involves a distortion of reality and a retreat from other people, accompanied by disturbances in affect, behavior, and cognition. B. Schizophrenia can be found around the world at the same rate: about 1 percent C. Recent research indicates that schizophrenia has three dimensions of symptoms. 1. Negative symptoms refer to emotional and social withdrawal, reduced energy and motivation, apathy and poor attention. 2. Positive psychotic symptoms (accounting for ¾ of all cases), include hallucinations and delusions. a. Hallucinations are false perceptions. b. Delusions are false beliefs. 3. Positive disorganized symptoms of schizophrenia include disorders of thinking and speech, bizarre behaviors, and inappropriate affect. D. The correlates of negative symptoms include structural abnormalities in the brain, a clearer genetic basis, more severe complications at birth, a lower educational level, poorer adjustment patterns before onset, and a poorer prognosis. E. Correlated with both types of positive symptoms are excesses of the neurotransmitter dopamine, relatively normal brain configuration, severe disruptions in early family life, over-activity and aggressiveness in adolescence, and a relatively good response to treatment. F. Not all of the data on typing schizophrenia has been supportive. G. The DSM-IV-TR characterizes schizophrenic subtypes as paranoid, disorganized, catatonic, and undifferentiated. XVI. The Causes of Schizophrenia A. Schizophrenia has a genetic basis (though not as clearly so as mood disorders). B. Schizophrenia is a disease of the brain. C. The role of dopamine in excess amounts in the brain is being investigated. D. Another theory is that some people are genetically prone to develop the symptoms of schizophrenia when they are exposed to stressors — the diathesis-stress model, again. E. Environmental risk factors for developing schizophrenia include a) complications during pregnancy or during delivery, b0 the age of the parents -- particularly that of the father, c) prenatal maternal infections, malnourishment, and stress. 21. Explain the characteristics of schizophrenia, including its prevalence and prognosis. 22. Present the three dimensions of symptoms associated with schizophrenia. 23. Distinguish between the positive and negative symptoms of schizophrenia. 24.. Discuss the factors suspected as causes of schizophrenia. Key Terms and Concepts abnormal_____________________________________________________________________ ______________________________________________________________________________ diagnosis______________________________________________________________________ ______________________________________________________________________________ etiology_______________________________________________________________________ ______________________________________________________________________________ comorbidity___________________________________________________________________ _____________________________________________________________________________ insanity_______________________________________________________________________ ______________________________________________________________________________ anxiety_______________________________________________________________________ ______________________________________________________________________________ generalized anxiety disorder_____________________________________________________ ______________________________________________________________________________ panic disorder_________________________________________________________________ ______________________________________________________________________________ phobic disorder________________________________________________________________ ______________________________________________________________________________ specific phobias________________________________________________________________ ______________________________________________________________________________ social phobias__________________________________________________________________ ______________________________________________________________________________ agoraphobia___________________________________________________________________ ______________________________________________________________________________ obsessive compulsive disorder____________________________________________________ ______________________________________________________________________________ obsessions_____________________________________________________________________ ______________________________________________________________________________ compulsions___________________________________________________________________ ______________________________________________________________________________ posttraumatic stress disorder (PTSD)______________________________________________ ______________________________________________________________________________ somatoform disorders___________________________________________________________ ______________________________________________________________________________ hypochondriasis_______________________________________________________________ ______________________________________________________________________________ somatization disorder___________________________________________________________ ______________________________________________________________________________ conversion disorder_____________________________________________________________ ______________________________________________________________________________ dissociative disorders___________________________________________________________ ______________________________________________________________________________ dissociative amnesia____________________________________________________________ ______________________________________________________________________________ dissociative fugue______________________________________________________________ ______________________________________________________________________________ dissociative identity disorder_____________________________________________________ ______________________________________________________________________________ personality disorders (PDs)______________________________________________________ ______________________________________________________________________________ antisocial personality disorder____________________________________________________ ______________________________________________________________________________ autism________________________________________________________________________ ______________________________________________________________________________ ADHD________________________________________________________________________ ______________________________________________________________________________ dementia______________________________________________________________________ _____________________________________________________________________________ 8. More than anything else, what is the difference between fear and anxiety? ___a. Fear is more commonly irrational; anxiety is rational. ___b. Fear involves the autonomic nervous system, anxiety does not. ___c. Fear is the symptom of a disorder; anxiety is not. ___d. Fear requires an object; anxiety does not. 9. Everything else being equal, which of these disorders has the best prognosis? ___a. schizophrenia ___c. phobic disorder ___b. dissociative identity disorder ___d. antisocial personality disorder 10. Constantly checking and rechecking to confirm that the front door is really locked may be a sign of ___a. a fugue state. ___c. a conversion disorder. ___b. a phobia. ___d. an obsessive-compulsive disorder. 11. Which of these is most likely to result from experiencing some real, life-threatening event? ___a. psychogenic fugue ___c. posttraumatic stress disorder ___c. child abuse ___d. panic attacks 12. By definition, what do the somatoform disorders have in common? ___a. either hallucinations or delusions ___b. bodily symptoms or complaints ___c. exaggerated fears and anxiety ___d. feelings of profound depression 13. The disorder that used to be called multiple personality disorder is ___a. significantly less common than it was 50 years ago. ___b. now one of the more common forms of schizophrenia. ___c. classified as a dissociative identity disorder. ___d. characterized by a sense of la belle indifference. 14. More than anything else, what do personality disorders have in common that makes them different from other varieties of psychological disorders? ___a. As a group, they are extremely rare. ___b. They involve significant levels of anxiety. ___c. They tend to begin at an early age and to be long lasting. ___d. They generally provide more distress for the person with the disorder than for others. 15. If someone experiences delusions, this symptom shows us a disorder of ___a. affect. ___c. cognition. ___b. behavior. ___d. affect, behavior, or cognition, depending. 16. Of these, which is NOT commonly thought to be a symptom of autism? ___a. first diagnosed in one’s late teens/early twenties ___b. difficulties with language and communication in general ___c. a lack of pointing or directing in getting someone’s attention. ___d. inattention, hyperactivity, aggression and/or stereotyped behaviors 17. Alzheimer’s dementia ___a. is a physical disease of the brain and, therefore, is not listed in the DSM-IV-TR. ___b. cannot be diagnosed before one’s death. ___c. occurs only in the elderly (persons over 75). ___d. is degenerative and deadly. 18. The collection of disorders called “mood disorders” has as its major symptom ___a. disorganized thinking and confusion. ___b. the experience of strange, unexplainable behaviors. ___c. disturbances of affect. ___d. cognitive disorientation. 19. By far, the most common form of mood disorder is ___a. depression. ___c. paranoia. ___b. bipolar. ___d. mania. 20. Concerning mood disorders, which of the following is FALSE? ___a. Depression is more common in women than in men. ___b. It is more common to find depression alone than mania alone. ___c. Depression generally occurs in a series of episodes. ___d. The symptoms of mania rarely recur or relapse. 21. Of these factors, which seems LEAST likely to be involved as a cause of depression? ___a. hormone levels ___c. neurotransmitters ___b. genetic predispositions ___d. biogenic amines 22. Which of these symptoms tends NOT to be associated with schizophrenia? ___a. high levels of felt anxiety ___b. social withdrawal and retreat from others ___c. flattened affect ___d. disturbed cognitions, including delusions 23. Which of these would be considered to be a positive symptom of schizophrenia? ___a. a good prognosis ___c. hallucinations ___b. loss of affect ___d. social withdrawal 24. About which statement concerning the causes of schizophrenia do we feel most certain? ___a. Dopamine causes schizophrenia. ___b. Schizophrenia results from child abuse. ___c. Schizophrenia runs in families. ___d. Parents of schizophrenic persons are cold and aloof. True/False 1. ____True ____False Insanity is a term that comes form the legal profession, not from psychology or psychiatry. 2. ____True ____False Classifying psychological disorders is a project that was begun in the 1950s and culminated in the first Diagnostic Manual in 1960. 3. ____True ____False By definition, psychological disorders must involve one’s affect, one’s behaviors, or one’s cognitions. 4. ____True ____False Although comorbidity is common among the personality disorders, it rarely occurs with the anxiety disorders. 5. ____True ____False Social phobias include the fears of eating in public and public speaking. 6. ____True ____False Although it is classified as an anxiety disorder, there is increasing evidence that OCD has a strong biological basis. 7.____Truw ____False Real disasters cause serious psychological harm (e.g. PTSD) in a minority of persons exposed to those disasters. 8. ____True ____False The phenomenon known as la belle indifference is best associated with conversion disorder. 9. ____True ____False People with antisocial disorder used to be called “psychopaths” or “sociopaths.” 10. ____True ____False Because attention-deficit hyperactivity disorder is a genetic/biological problem, psychological interventions are of little help in treatment. 11. ____True ____False Rates of death attributed to Alzheimer’s dementia have increased markedly over the past 35 years. 12. ____True ____False By definition, patients cannot be depressed and anxious at the same time. 13. ____True ____False Dysthymia is another (technical) term for major depressive disorder. 14. ____True ____False Schizophrenia means “split mind” — literally, splitting of the mind into two (or more) different, yet distinct, personalities. 15. ____True ____False About one-quarter of those diagnosed with schizophrenia will simply never get better. 16. ____True ____False Although women are diagnosed with major depression more often than men are, they are probably over-diagnosed and do not truly experience any more depression. 15. T And about one-quarter will get better and stay that way, while about half seem to get better for awhile and then (for a myriad of reasons) relapse, and have their symptoms return. 16. F No, the hypothesis seems reasonable, but it turns out that women really do experience more depression than men do. The big question is why this is the case Experiencing Psychology What Do People Believe About Psychological Disorders? There are popular misconceptions about many areas of psychology, but in none more so than in abnormal psychology. This simple, 10-item, true-and-false survey will give you some insight to the mistaken ideas that many people have about the psychological disorders. It might be interesting to compare the responses of persons who have had a psychology class with the responses of those who have not. ___T ___F 1. Most violent crimes are committed by persons who are mentally ill. ___T ___F 2. People with psychological disorders are obvious; they act in some bizarre way. ___T ___F 3. This week, more people will be diagnosed with psychological disorders than with cancer and cardiovascular disease combined. ___T ___F 4. Except in rare cases, a clear distinction can be drawn between “normal” and “abnormal” behaviors. ___T ___F 5. Geniuses are particularly prone to psychological disorders. ___T ___F 6. Psychological disorders are more prevalent in highly technical, advanced, societies. ___T ___F 7. Most mental disorders are incurable. ___T ___F 8. People with mental illness seldom realize that they are ill. ___T ___F 9. Mental illness is about as common among children and adolescents as it is among adults. ___T ___F 10. If a person is diagnosed with one psychological disorder, he or she almost certainly will not have another, different disorder as well. As you know, Items number 3, 6, and 9 are true, while the others are false. Psychology on the Internet 1. ANXIETY DISORDERS, SOMATOFORM DISORDERS, DISSOCIATIVE DISORDERS, PERSONALITY DISORDERS, and AUTISM I suspect that I need not caution, “handle with care” for the Internet websites on the issues raised in Chapter 12. There are millions of them. Almost all are at worst well-intentioned sites maintained by well-trained and well-intentioned practitioners of psychology. Most websites exist in an attempt to be helpful, but as students of psychology we are looking for information, not assistance with personal problems. As has been the case for previous chapters, what is listed below is a sample, but I feel that it is a sampling of websites that offer a well-rounded, scientific approach to psychological disorders. The websites that are listed here for our chapter on psychological disorders are also relevant for many sections of Chapter 13 on treatment and therapy for those disorders. Lastly, this is another chapter for which we have mega-sites that simply do not break down coverage to suit our outline. The Internet simply covers psychological disorders. http://www.mentalhealth.com (a monster site with hundreds of links, titled “Internet Mental Health” — which may sound suspicious. From the homepage, click on “Disorders.” For each disorder on the list you get both an American and a European description, articles on treatment, and links to recent research, booklets, magazine articles, and other Internet website links. If you were to explore each of the disorders and each of the links provided, a) the semester would be over by the time you finished, but b) you would have encountered nearly all there is know!) http://www.nami.org (The National Alliance for the Mentally Ill sponsors this extensive website. Their mission statement claims that they are “dedicated to the eradication of mental illness and to the improvement of quality of life of all whose lives are affected by these diseases.” As you would expect, this is a very compassionate as well as informative website.) http://www.mentalhealth.samhsa.gov (the website of the National Mental Health Information Center — developed “for users of mental health services and their families, the general public, policy makers, providers, and the media.” As a huge government-sponsored website, it provides a great deal of information, but require patience to navigate it fully.) 3. MOOD DISORDERS Yes, mania is a possible symptom of mood disorders, but there is little doubt that what we are talking about here is depression. One of the difficulties with depression is separating the normal depression of loss and grief from the depression of dysthymia and the symptoms of a major depressive disorder. These websites might help you sort out those distinctions. http://www.adolescent-mood-disorders.com (I expected a website on mood disorders in teenagers to be more oriented toward teens — not their parents. Nonetheless, there are some good, informative links to be found on this homepage.) http://www.depression.com (GlaxoSmithKline, a pharmaceutical company that markets a line of anti-depressant medications funds this website, so beware of the possibilities of bias. At very least, their link to “Understanding Depression” is a very good one.) http://www.psychologyinfo.com/depression (We have visited this site before, and return for good reason. The vertical toolbar on the left provides the links you will need. Or even better, scroll down to the list of links at the bottom of the page and pick and choose.) http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm (a government-sponsored Internet presence dealing with mood disorders—the site of the National Institute of Mental Health. It is not clear at first, but there are dozens of active links on this page.) 4. SCHIZOPHRENIA There is no reason to repeat my claims about how devastating this disorder/ disease can be. Always remember, however, that people with schizophrenia are like people with any disease or disorder—some are more severely afflicted than others. These websites will give you additional, up-to-date information. http://www.schizophrenia.com (“The World’s No. 1 Schizophrenia Website” is the claim. It is a busy, well designed website. So, it is a sort of do-it-yourself effort, and from that perspective it is impressive. Still, I suggest that you tread with a bit of care.) http://www.narsad.org (The National Alliance for Research on Schizophrenia and Depression—is a donor-supported research organization. This website is not as rich or deep as many, but what you find here will be “cutting edge.”) http://www.psychologyinfo.com (starts with a nice summary piece, then offers 14 wonderful links)