2023学年完整公开课版Lecture16Psychologicaldisorders

Lecture16:PsychologicalDisordersWhatisNormal?Psychopathology:Scientificstudyofmental,emotional,andbehavioraldisordersSubjectiveDiscomfort:Feelingsofdiscomfort,unhappiness,oremotionaldistressStatisticalAbnormality:Havingextremescoresonsomedimension,suchasintelligence,anxiety,ordepressionSocialNonconformity:Disobeyingsocietalstandardsfornormalconduct;usuallyleadstodestructiveorself-destructivebehaviorFIGURE12.1Thenumberofpeopledisplayingapersonalcharacteristicmayhelpdefinewhatisstatisticallyabnormal.WhatIsNormal?(cont'd)SituationalContext:Socialsituation,behavioralsetting,orgeneralcircumstancesinwhichbehaviortakesplaceIsitnormaltowalkaroundstrangersnaked?Ifyouareinalockerroomandintheshowerarea,yes!CulturalRelativity:Judgmentsaremaderelativetothevaluesofone’scultureDefiningAbnormalBehavior

(MentalIllness)MaladaptiveBehavior:Behaviorthatmakesitdifficulttofunction,toadapttotheenvironment,andtomeeteverydaydemandsMentalDisorder:SignificantimpairmentinpsychologicalfunctioningDefiningAbnormalBehavior

(MentalIllness)PsychoticDisorder:hallucinationsanddelusions,socialwithdrawal,andamoveawayfromrealityOrganicMentalDisorder:Mentaloremotionalproblemcausedbybrainpathology(i.e.,braininjuriesordiseases)MoodDisorder:Disturbancesinaffect(emotions),likedepressionormaniaAnxietyDisorder:Feelingsoffear,apprehension,anxiety,anddistortedbehaviorDefiningAbnormalBehavior

(MentalIllness)SomatoformDisorder:Physicalsymptomsthatmimicdiseaseorinjury(blindness,anesthesia)withoutidentifiablephysicalcauseDissociativeDisorder:Temporaryamnesia,multiplepersonality,ordepersonalization(likebeinginadreamworld,feelinglikearobot,feelinglikeyouareoutsideofyourbody)PersonalityDisorder:Deeplyingrained,unhealthy,maladaptivepersonalitypatternsSexualandGenderIdentityDisorder:Problemswithsexualidentity,deviantsexualbehavior,orsexualadjustmentDefiningAbnormalBehavior

(MentalIllness)SubstanceRelatedDisorders:Abuseordependenceonamindormood-alteringdrug,likealcoholorcocainePersoncannotstopusingthesubstanceandmaysufferwithdrawalsymptomsiftheydoNeurosis:Archaic;onceusedtorefertoexcessiveanxiety,somatoform,dissociativedisorders,andsomekindsofdepressionDSMDSM—Diagnostic&StatisticalManualofMentalDisordersPublishedbyAmericanPsychiatricAssociationusedbycliniciansandresearcherstodiagnoseandclassifymentaldisordersGeneralRiskFactorsforMentalIllnessBiologicalFactors:Geneticdefectsorinheritedvulnerabilities;poorprenatalcare,headinjuries,exposuretotoxins,chronicphysicalillness,ordisabilityPsychologicalFactors:Lowintelligence,learningdisorders

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SocialConditions:Poverty,homelessness,overcrowding,stressfullivingconditionsFamilyFactors:Parentswhoareimmature,mentallyill,abusive,orcriminal;poorchilddiscipline;severemaritalorrelationshipproblemsOthersourcesofpsychologicalstressFigure12.11FIGURE12.11Acombinationofvulnerabilityandstressmayproducepsychologicalproblems.Thetopbarshowslowvulnerabilityandlowstress.Theresult?Noproblem.Thesameistrueofthenextbardown,wherelowvulnerabilityiscombinedwithmoderatestress.Evenhighvulnerability(thirdbar)maynotleadtoproblemsifstresslevelsremainlow.However,whenhighvulnerabilitycombineswithmoderateorhighstress(bottomtwobars)theperson“crossestheline”andsuffersfrompsychopathology.PersonalityDisorders:AntisocialPersonalityDisorder(ASPD)Definition:Apersonwholacksaconscience(superego?);typicallyemotionallyshallow,impulsive,selfish,andmanipulativetowardothersOftentimescalledpsychopathsorsociopathsManyaredelinquentsorcriminals,butmanyareNOTcrazedmurderersdisplayedontelevisionCreateagoodfirstimpressionandareoftencharmingCheattheirwaythroughlife(e.g.,Dr.MichaelSwango)BlindtosignsofdisgustinotherpeopleASPD:CausesandTreatmentsPossibleCauses:Childhoodhistoryofemotionaldeprivation,neglect,andphysicalabuseUnderarousalofthebrainVerydifficulttoeffectivelytreat;willlie,charm,andmanipulatetheirwaythroughtherapyAnxiety-BasedDisorders

Anxiety:Feelingsofapprehension,dread,oruneasinessAdjustmentDisorders:WhenongoingstressorscauseemotionaldisturbanceandpushpeoplebeyondtheirabilitytoeffectivelycopeUsuallysuffersleepdisturbances,irritability,anddepressionExamples:Griefreactions,lengthyphysicalillness,unemploymentcanbesometriggersforanxietyAnxiety-BasedDisorders(cont'd)AnxietyDisorders:Whenstressseemsgreatlyoutofproportiontothesituationathand…usuallyaccompaniedbysomeformofavoidance3MainTypesGeneralizedAnxietyDisorder(GAD):Durationofatleastsixmonthsofchronic,unrealistic,orexcessiveanxietyPanicDisorder(w/orw/oagoraphobia)PhobiaGeneralizedAnxietyDisorderExtremeanxiousnessandworryforatleast6monthsAnxiousness/anxietydonotfadewhenlifecircumstancesgetbetterMultipletopicsofworryPanicDisordersPanicDisorder(withoutAgoraphobia):Achronicstateofanxietywithbriefmomentsofsudden,intense,unexpectedpanic(panicattack)PanicAttack:Feelslikeoneishavingaheartattack,goingtodie,orisgoinginsaneSymptomsincludevertigo,chestpain,choking,fearoflosingcontrolPanicDisorder(withAgoraphobia):Panicattacksandsuddenanxietystilloccur,butwithagoraphobiaAgoraphobiaAgoraphobia(with

PanicDisorder):Intense,irrationalfearthatapanicattackwilloccurinapublicplaceorinanunfamiliarsituationIntensefearofleavingthehouseorenteringunfamiliarsituationsCanbeverycripplingLiterallymeansfearofopenplacesormarket(agora)Agoraphobia(without

PanicDisorder):Fearthatsomethingextremelyembarrassingwillhappenawayfromhomeorinanunfamiliarsituation.SpecificPhobiasIrrational,persistentfears,anxiety,andavoidancethatfocusonspecificobjects,activities,orsituationsPeoplewithphobiasrealizethattheirfearsareunreasonableandexcessive,buttheycannotcontrolthem.SocialPhobiaIntense,irrationalfearofbeingobserved,evaluated,humiliated,orembarrassedbyothers(e.g.,shyness,eating,orspeakinginpublic)Review:3AnxietyDisorders1.Phobia—objects,situation,socialCauses:notonlyexperience…alsoinherittendencies(preparedfears)2.GeneralizedAnxiety—constantanxietyandworry3.PanicDisorder—discretepanickyepisodesObsessive-CompulsiveDisorder(OCD)

ExtremepreoccupationwithcertainthoughtsandcompulsiveperformanceofcertainbehaviorsObsession:RecurringimagesorthoughtsthatapersoncannotpreventCauseanxietyandextremediscomfortEnterintoconsciousnessagainsttheperson’swillMostcommon:Beingdirtyorwonderingifyouperformedanaction(turnedoffthestove)CompulsionsCompulsion:Irrationalactsthatpersonfeelscompelledtorepeatagainsthis/herwillHelptocontrolanxietycreatedbyobsessionsCheckersandcleanersTable16.2Obsessive-CompulsiveTendenciesAnxietyFeelingsoftension,uneasiness,apprehension,worry,andvulnerabilityWearemotivatedtoavoidexperiencinganxietyFigure10.6FIGURE10.6Theapproximaterelationshipbetweentheid,ego,andsuperego,andthelevelsofawareness.TheoreticalCausesofAnxietyDisorders:PsychodynamicPsychodynamic(Freud):Anxietycausedbyconflictsamongid,ego,andsuperego.Forbiddenidimpulsesforsexoraggressionaretryingtobreakintoconsciousnessandthusinfluencebehavior;personfearsdoingsomethingcrazyorforbidden.Superegocreatesguiltinresponsetotheseimpulses.Egogetsoverwhelmedandusesdefensemechanismstocope.OtherTheoreticalCausesofAnxietyDisordersHumanistic-Existential:Unrealisticself-imageconflictswithtrueselfOtherTheoreticalCausesofAnxietyDisordersBehavioristic:Anxietysymptomsandbehaviorsarelearned,likeeverythingelseConditionedemotionalresponsesgeneralizetonewsituationsAnxietyReductionHypothesis:Whenrewardofimmediaterelieffromanxietyperpetuatesself-defeatingavoidancebehaviorsCognitive:Whendistortedthinkingcausespeopletomagnifyordinarythreatsandfailures,leadingtoanxietyanddistressFreudianDefenseMechanismsDefenseMechanisms:Habitualandunconscious(inmostcases)psychologicalprocessesdesignedtoreduceanxietyMoreonDefenseMechanismsWorkbyavoiding,denying,ordistortingsourcesofthreatoranxietyIfusedshortterm,canhelpusgetthrougheverydaysituationsIfusedlongterm,wemayendupnotlivinginrealityProtectidealizedself-imagesowecanlivewithourselvesFreudianDefenseMechanisms:SomeExamplesDenial:Mostprimitive;denyingreality;usuallyoccurswithdeathandillnessRepression:Whenpainfulmemories,anxieties,andsoonareheldoutofourawarenessReactionFormation:ImpulsesarerepressedandtheoppositebehaviorisexaggeratedMoreDefenseMechanismsProjection:Whenone’sownfeelings,shortcomings,orunacceptabletraitsandimpulsesareseeninothers;exaggeratingnegativetraitsinotherslowersanxietyRationalization:Justifyingpersonalactionsbygiving“rational”butfalsereasonsforthemNamethatdefensemechanism!Yourex-spouse,whocheatedonyou,writesabest-sellingnonfictionbookarguingthathumanbeingsarenotnaturallymonogamousandhaveaninstinctiveneedforvariety.Namethatdefensemechanism!Youareinlovewithyourbestfriend’snewflame.Thefriendshipisanoldoneandveryvaluabletoyou.Youtelleverybodythatyourfriend’snewloveinterestisaterriblehumanbeingandyoudon’tunderstandtheattractionatall.MoodDisordersMajordisturbancesinemotion,suchasdepressionormaniaDepressiveDisorders:Sadnessordespondencyareprolonged,exaggerated,orunreasonableBipolarDisorders:Involvebothdepression,andmaniaorhypomaniaSeasonalAffectiveDisorder(SAD):Depressionthatonlyoccursduringfallandwinter.MayberelatedtoreducedexposuretosunlightPhototherapy:ExtendedexposuretobrightlighttotreatSADMajorMoodDisordersLastingextremesofmoodoremotionandsometimeswithpsychoticfeatures(hallucinations,delusions)MajorDepressiveDisorder:Amooddisorderwherethepersonhassufferedoneormoreintenseepisodesofdepression;oneofthemoreseriousmooddisorders.BipolarIDisorder:Extrememaniaanddeepdepression;onetypeofmanic-depressiveillness.Mania:Excited,hyperactive,energetic,grandiosebehaviorBipolarIIDisorder:Personismainlysadbuthasoneormorehypomanicepisodes(mildmania)Suicide:MajorRiskFactorsDrugoralcoholabusePriorsuicideattemptDepressionorothermooddisorderAvailabilityofafirearmSevereanxietyorpanicattacksFamilyhistoryofsuicidalbehaviorShame,humiliation,failureorrejectionFigure12.14FIGURE12.14Adolescentsuicideratesvaryfordifferentracialandethnicgroups.Higherratesoccuramongwhitesthanamongnon-whites.Whitemaleadolescentsrunthehighestriskofsuicide.Consideringgenderalone,itisapparentthatmoremalethanfemaleadolescentscommitsuicide.Thisisthesameasthepatternobservedforadults.Figure12.15FIGURE12.15Suicidalbehaviorusuallyprogressesfromsuicidalthoughts,tothreats,toattempts.Apersonisunlikelytomakeanattemptwithoutfirstmakingthreats.Thus,suicidethreatsshouldbetakenseriouslyCommonCharacteristicsofSuicidalThoughtsandFeelings(Shneidman)EscapeUnbearablePsychologicalPain:EmotionalpainthatthepersonwishestoescapeFrustratedPsychologicalNeeds:Suchassearchingforlove,achievement,orsecurityConstrictionofOptions:FeelinghelplessandhopelessanddecidingthatdeathistheonlyoptionleftStressDisordersOccurwhenstressesoutsiderangeofnormalhumanexperiencecausemajoremotionaldisturbanceSymptoms:Relivingtraumaticeventrepeatedly,avoidingremindersoftheevent,andnumbingofemotionsAcuteStressDisorder:PsychologicaldisturbancelastinguptoonemonthfollowingstressesfromatraumaticeventPost-TraumaticStressDisorder(PTSD)PTSDlastsmorethanonemonthafterthetraumaticeventhasoccurred;maylastforyearsTypicallyassociatedwithcombatandviolentcrimes(rape,assault,etc.)DissociativeDisordersDissociativeAmnesia:Inabilitytorecallone’sname,address,orpastMemorylossispartialorcompleteforpersonalinformationDissociativeFugue:SuddentravelawayfromhomeandconfusionaboutpersonalidentityDissociativeIdentityDisorder(DID)Personhastwoormoredistinct,separateidentitiesorpersonalitytraits;previouslyknownasMultiplePersonalityDisorder“Sybil”or“TheThreeFacesofEve”aregoodexamplesOftenbeginswithhorrificchildhoodexperiences(e.g.,abuse,molestation,etc.)TherapyoftenmakesuseofhypnosisSomatoformDisordersHypochondriasis:PersonispreoccupiedwithfearsofhavingaseriousillnessordiseaseInterpretnormalsensationsandbodilysignsasproofthattheyhaveaterriblediseaseNophysicaldisordercanbefoundSomatizationDisorder:PersonexpressesanxietiesthroughnumerousphysicalcomplaintsManydoctorsareconsultedbutnoorganicorphysicalcausesarefoundSomatoformDisorders(cont'd)PainDisorder:Painthathasnoidentifiableorganic,physicalcauseAppearstohavepsychologicaloriginConversionDisorder:Severeemotionalconflictsare“converted”intophysicalsymptomsoraphysicaldisabilityCausedbyanxietyoremotionaldistressbutnotbyphysicalcausesGloveAnesthesia:LossofsensitivityinareasofskinnormallycoveredbyagloveFigure12.4FIGURE12.4(left)“Glove”anesthesiaisaconversionreactioninvolvinglossoffeelinginareasofthehandthatwouldbecoveredbyaglove(a).Iftheanesthesiawerephysicallycaused,itwouldfollowthepatternshownin(b).(right)Totestfororganicparalysisofthearm,anexaminercansuddenlyextendthearm,stretchingthemuscles.Aconversionreactionisindicatedifthearmpullsbackinvoluntarily.OtherTheoreticalCausesof

AnxietyDisordersHumanistic-Existential:Unrealisticself-imageconflictswithrealself-imageExistential:Anxietyreflectslossofmeaninginone’slifeBehavioristic:Anxietysymptomsandbehaviorsarelearned,likeeverythingelseConditionedemotionalresponsesthatgeneralizetonewsituationsMoreTheoreticalCausesof

AnxietyDisordersAvoidanceLearning:WhenmakingaparticularresponsedelaysorpreventstheonsetofapainfulorunpleasantstimulusAnxietyReductionHypothesis:Whenrewardofimmediaterelieffromanxietyperpetuatesself-defeatingavoidancebehaviorsCognitive:Whendistortedthinkingcausespeopletomagnifyordinarythreatsandfailures,leadingtoanxietyanddistressPsychosisPsychosis:Lossofcontactwithrealitymarkedbyhallucinations,delusions,disturbedthoughtsandemotions,andpersonalitydisorganizationOtherPsychoticDisordersOrganicPsychosis:PsychosiscausedbybraininjuryordiseaseDementia:Mostcommonorganicpsychosis;seriousmentalimpairmentinoldagecausedbybraindeteriorationKnownassenilityattimesAlzheimer’sDisease:Mostcommoncauseofdementia;symptomsincludeimpairedmemory,confusion,andprogressivelossofmentalabilitiesRonaldReaganmostfamousAlzheimer’svictimDelusionalDisordersMarkedbypresenceofdeeplyheldfalsebeliefs(delusions)Usuallyinvolvedelusionsofgrandeur,persecution,orjealousyParanoidPsychosis:MostcommondelusionaldisorderCentersondelusionsofpersecutionSchizophrenia:

TheMostSevereMentalIllnessPsychoticdisordercharacterizedbyhallucinations,delusions,apathy,thinkingabnormalities,and“split”betweenthoughtsandemotionsDoesNOT

refertohavingsplitormultiplepersonalitiesDelusionsDelusions:Falsebeliefsthatpsychoticindividualsinsistaretrue,regardlessofoverwhelmingevidenceagainstthemCommonforms: ErotomanicGrandioseJealousPersecutionSomaticHallucinationsHallucinations:Imaginarysensations,suchasseeing,hearing,orsmellingthingsthatdonotexistintherealworldMostcommonpsychotichallucinationishearingvoicesNotethatolfactoryhallucinationssometimesoccurwithseizuredisorder(epilepsy)SomeMorePsychoticSymptomsFlatAffect:LackofemotionalresponsivenessInappropriateemotions:DisturbedVerbalCommunication:Garbledandchaoticspeech;wordsaladPersonalityDisintegration:Uncoordinatedthoughts,actions,andemotions…a“split”betweenthoughtandemotionWithdrawalandapathyBreakdownofpersonalhabitsProblemswithselectiveattentionTheFourSubtypesofSchizophreniaDisorganizedSchizophrenia:Incoherence,grosslydisorganizedbehavior,bizarrethinking,andflatorgrosslyinappropriateemotionsCatatonicSchizophrenia:Markedbystuporwherevictimmayholdsamepositionforhoursordays;alsounresponsiveParanoidSchizophrenia:Preoccupationwithdelusionsofgrandeurorpersecution;alsoinvolveshallucinationsthatarerelatedtoasingletheme,especiallygrandeurorpersecutionUndifferentiatedSchizophrenia:Anytypeofschizophreniathatdoesnothaveparanoid,catatonic,ordisorganizedfeaturesorsymptomsCausesofSchizophreniaPsychologicalTrauma:Psychologicalinjuryorshock,oftencausedbyanenvironmentofviolence,abuse,orneglectDisturbedFamilyEnvironment:Stressfulorunhealthyfamilyrelationships,communicationpatterns,andemotionalatmosphereDeviantCommunicationPatterns:Causeguilt,anxiety,anger,confusion,andturmoilHeredity—ifoneidenticaltwinbecomesschizophrenicthentheothertwinhasabout50%chanceStress-VulnerabilityHypothesis:CombinationofenvironmentalstressandinheritedsusceptibilitycausepsychoticdisordersFigure12.7FIGURE12.7Lifetimeriskofdevelopingschizophreniaisassociatedwithhowcl