chapman chapters 14 and 15 part i psychological disorders 3 slide blackboard version
TRANSCRIPT
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Psychological
DisordersDr. 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 disordersdefined?
Specific criteria DSM-V (May 2013)
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Figure 14.1 Sample DSM-IV-TR Diagnostic CriteriaHockenbury: Psychology, Fourth EditionCopyright 2005 by Worth Publishers
Psychological Disorders
How are psychological disordersdefined?
Personal distress Impairment in functioning
Psychological Disorders
The National Comorbidity Study (Kessleret al., 1994)
NCS Revised (2005) Prevalence of Psychological Disorders insample of people representative of the
general U.S. population: Lifetime and Past
Year
Rates of Treatment Seeking
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National Comorbidity SurveyReplication Results
Approximately 46% of adults experienced apsychological disorder at least once in their
lives
About 26% of people experienced apsychological disorder in the past year
Approximately 59% who experiencedsymptoms in the last year did NOT seek
treatment
NCS-R -Age of Onset andLifetimePrevalence ofMental Disorders
National Comorbidity SurveyReplication (NCS-R): One out of fourrespondents (26 percent) reportedexperiencing symptoms of apsychological disorder duringprevious year
NCS-R found one out of two adults(46 percent) experienced symptomsof a psychological disorder at somepoint in lives
Different categories of mentaldisorders vary significantly in themedian age of onset
NCS-R found that most people withthe symptoms of a mental disorder(59 percent) received no treatmentduring the past year
Approximately 80 percent whoexperienced symptoms in the lastyear did not seek treatment
Most people seem to deal withsymptoms without completedebilitation
Clicker Q next
Anxiety: What is it? How Does It Differ
From Fear?
FEARAn emotion alarmresponding to a present dangerTruealarmSpecific, or focalAdaptiveExample: Angry DogANXIETYFalsealarm responding topossible dangerVague feeling of anticipatoryapprehensionPrimes the pump for fearCan be maladaptiveExample: Angry Dog
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Anxiety
Cognitive: thoughts of what if, catastrophic thoughts Subjective (e.g., feelings of fear and apprehension) Physiological Behavioral: Maladaptive behaviors to reduce anxiety Everyone experiences it; 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 dont know if this event willhappen again, but I have to be prepared just in case!
Types of Anxiety Disorders
Most common diagnosed disorders throughoutthe 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 likelythan children of non-anxious parents to develop an
anxiety disorder
Generalized Anxiety DisorderWorrying About Anything and Everything
Explaining Generalized AnxietyDisorder (GAD)
Environmental,psychological, andgenetic factors, as wellas other biologicalfactors, are probablyinvolved in GAD
Problematic anxietycan be evident from avery early age
Early stressfulexperiences maycontribute
Anxiety disordercharacterized byexcessive, global, andpersistent symptoms of
anxiety; also calledfree-floating anxiety In generalized anxiety
disorder, when onesource of worry isremoved, anothermoves in to take itsplace
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Panic Attacks andPanic DisordersSudden Episodes of Extreme Anxiety
Pounding heart
Rapid breathing
Breathlessness
Choking sensationSweating, trembling, and
experiencing light-headedness
Chills or hot flashes
Escalating surge of physicalarousal
Feelings of terror and belief that
one is about to die, go crazy, orlose control
Panic attackSudden episode of
extreme anxiety thatrapidly escalates in
intensity
Symptoms:
Typically peaks within 10minutes of onset and then
gradually subsides
Panic Disorder
An anxiety disorder in whichthe person experiences
frequent and unexpectedpanic attacks
Frequency of panic attacks is highly variable and quite unpredictable Very frighteningsufferers live in fear of having them Agoraphobia often develops as a result gradually subsides
Panic Disorder
Panic attacks - helpless terror,high physiological arousal
Very frightening - sufferers live infear of having them
Agoraphobiaoften develops as aresult
Agoraphobia
Anxiety about placeswhere panic may occur
and escape is difficult
Afraid that help wontbe available if one
panics Crowds, malls,
supermarkets,elevators, etc
Client examples Case example
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Explaining PanicDisorder
Barlow: Triple vulnerabilities model of panic based on combination of
Biological predisposition toward anxietyLow sense of control over potentially life-threatening eventsOversensitivity to physical sensations
Catastrophic cognitions theory
People with panic disorder are not only oversensitive
to physical sensations they also tend tocatastrophize meaning of their experience
The PhobiasFear and Loathing
Encountering feared situation or object can provoke a full-fledgedpanic attack
About 13 percent of the general population experiences a specificphobia
More than twice as many women as men suffer from specificphobia
Phobia
Persistent and irrational fear of a specific object, situation, or activity
Specific Phobia
Excessive, intense, and irrational fear of a specific object, situation, or
activity that is actively avoided or endured with marked anxiety
Four PrimaryCategories 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) Animals2) Heights3) Flying4) Blood/Injection
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Explaining PhobiasLearning Theories: Di#erent pathways
Classical Conditioningas seen in the Watson
and Raynerdemonstration with Little
Albert
Operant Conditioningwe are rewarded by
reducing ourconditioned fear by
avoidance of theconditioned stimulus,
an example of negativereinforcement
Observational Learningwe model and imitatethe fears we see in
others
Biological Preparation certain fears, such as tospiders or heights, have an evolutionary history;
may represent a fear of contamination: spoiledfoods, infection, parasites
Specific Phobia: Pathways
Phobia Clip
http://vimeo.com/38121852
(Begin at 14:00)
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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.e., anxiety)
Systematic Desensitization is NOT the most effectivetreatment for phobias today.
Exposure and Cognitive work (explain in treatment section)
Comparing AnxietyDisorders --
Agoraphobia: Fear of panic attacks in placeswhere help or escape options seemunavailable
Social Anxiety Disorder (formerly socialphobia): Fear of Social Situations
Panic Disorder: fear of fear
About one out of eight adults inthe United States have experienced
social phobia at some point in theirlives.
SAD is far more debilitating thaneveryday shyness.
People with SAD are intenselyfearful of being watched or judgedby others.
Even ordinary activities, such aseating with friends in a shoppingmall food court, can cause
unbearable anxiety. Most common fear throughout the
United States is (drumroll) PublicSpeaking
Social Anxiety Disorder
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Anxiety Disorders: Social Anxiety
Disorder Persistent fear of one or more
social or performancesituations
Severe anxiety upon exposureto social situations whereridicule may occur Similar to panic attack
Social situation avoided orendured with significantanxiety i.e., formal speaking, group
meetings, class participation
Case example
Posttraumatic Stress Disorder
(PTSD)
Follows traumaticevent or events suchas war, rape, orassault
Symptoms include: INTRUSIONS (e.g,
nightmares, flashbacks)
AVOIDANCE HYPERAROUSAL
(e.g., sleeplessness,easily startled,irritability)
Causes
The symptoms of posttraumaticstress disorder can apparently
last a lifetime. More than 60 years after the
close of World War IIthousands of veterans, now in
their eighties, still suffer from
nightmares, anxiety, and otherPTSD symptom
Some experts estimate that asmany as 200,000 World War II
veterans may continue to sufferfrom the symptoms of PTSD
PTSD
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CompulsionsRepetitive behaviors or
mental acts that areperformed to prevent or
reduce anxietyMay be overt or covert
ObsessionsRepeated, intrusive, anduncontrollable irrational
thoughts or mental images thatcause extreme anxiety and
distress
Common fear of dirt, germs;pathological doubt abouthaving completed a task
ObsessiveCompulsive DisorderChecking It Again and Again
Often accompanied by an irrational belief that failure to performritual action will lead to catastrophe
Usually both obsessions and compulsions are present and thesufferer cant resist them even though they know they are absurd
Content mirrors cultural beliefs United States fear of germs India concerns about religious purity
An anxietydisorder in
which
symptoms ofanxiety aretriggered by
intrusive,repetitive
thoughts andurges to
perform certainactions.
OCD: Anxiety Disorder but notits 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)
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Dysfunction in specific brainareas
Areas involved in the fight-or-flight response
Frontal lobes, which play a key
role in our ability to think andplan ahead
Heightened neural activity incaudate nucleus involved in
regulating movements
Deficiency in serotonin,
norepinephrine implicated
Drugs that increase the
availability of theseneurotransmitters decrease
symptoms
Explaining ObsessiveCompulsive Disorder
Excessive responsibility, guilt, and rigid codes of conduct may predisposesomeone to OCD Generalized and specific psychological vulnerabilities May create thought-action fusionwhich is related to OCD symptoms Intrusions produce distress when they have idiosyncratic meaning So, certain intrusive thoughts are learned as unacceptablebecause they
signal danger for which the person feels personally responsible
OCD Clip
http://vimeo.com/53904764
(Stop at about 8 minutes)
Mood Disorders (Affective Disorders)
Major Depression Dysthymic Disorder
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Depression
Major Depression More severe depression lasts without remission for at least 2 weeks
Dysthymia less severe, 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 areaffected by major depression
Lifetime prevalence, about 15 percent ofAmericans at some point in their lives
Women are about twice as likely as men tobe affected by major depressionWomen more vulnerable becauseExperience greater degree of chronicstress in daily life
Have lesser sense of personal controlMore prone to dwell on their problems
Course of Major Depression
Left untreated,symptoms of
major depressioncan easily lastsix months or
longer
Left untreated,depression may
recur andbecome
progressivelymore severe
More than half of allpeople who havebeen through oneepisode of majordepression can
expect a relapse,usually within two
years
Symptoms tendto increase inseverity and
time between
episodesdecreases
Situational Bases forDepression
Positive correlationbetween stressful lifeevents and onset ofdepression.
Does life stress causedepression?
Most life events that causedepression are losses (ofa spouse or companion,long-term job, health, orincome)
The Symptoms of Major Depression The experience of major depression canpermeate every aspect of life. This figure shows some of the most common
emotional, behavioral, cognitive, and physical symptoms of that disorder.
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Biological Bases for Depression
Genetic vulnerability Neurotransmitter theories
Low levels norepinephrine Low levels serotonin
Can Depression be Treated?
Most cases of depression can be effectivelytreated
Antidepressants Cognitive-Behavioral Therapy Both