Psychopathology
-scientific study of the origins, symptoms, and development of psychological disorders

psychological disorder (mental disorder)
-pattern of behavioral or psychological symptoms that causes significant personal distress, impairs the ability to function in one or more important areas of life, or both (DSM-IV-TR, 2000)
-pattern of behavioral or psychological symptoms must represent a serious departure from the prevailing social and cultural norms

DSM-IV_TR (Diagnostic and Statistical Manual of Mental Disorders)
-book that describes more than 300 specific psychological disorders
-includes symptoms, exact criteria that must be met to make a diagnosis, and the typical course for each mental disorder
-provides mental health professionals with both a common language for labeling and comprehensive guidelines for diagnosing mental disorders
-not written by a single person or group but is the consensus of a wide range of mental health professionals from many different organizations and perspective

Criticisms of DSM-IV-TR
-includes some experiences that are too “normal” to be considered disorders like excessive shyness
-using arbitrary cutoffs to draw the line b/w people w/ and w/o a particular disorder
-gender bias
-insufficient sensitivity to cultural diversity

National Commorbidity Survey Replication (NCS-R)
-survey involving more than 2 years of face-to-face interviews throughout the country
-participants asked if they had experienced specific symptoms of psychological disorders
-results reconfirm many of the findings of previous national surveys
-reveal a high degree of comorbidity

comorbidity
-people diagnosed with one disorder are also frequently diagnosed with another disorder as well

Results of NCS-R
-found that 1 out of 4 respondents reported experiencing symptoms of a psychological disorder during the previous year

-NCS-R found that almost 1 out of 2 adults had experienced symptoms of a psychological (mental) disorder at some point thus far in life

-found that most people with mental disorder symptoms received not treatment

Factors that contribute to unmet psychological help
-lack of insurance, low income, and living in rural areas where mental health care facilities might not be available
-some shun treatment for fear of being stigmatized for seeking help w/ troubling psychological symptoms
-most people manage to weather psychological symptoms without being completely debilitated and needing professional intervention

Why ineffective strategies can appear to be effective
-many psychological disorder symptoms diminish with the simple passage of time or with improvements in the person’s overall situation

Anxiety
-that feeling of tension, apprehension, and worry that often hits during personal crisis in everyday conflicts
-your personal, internal alarm system that tells you that something is not quite right
-Women alerts you to realistic threat, anxiety is adaptive and normal

Physical anxiety alert
-prepare you to defensively fight or flight potential dangers

Mental anxiety alert
-making you focus your attention squarely on the threatening situation
-You become extremely vigilant, scanning the environment for potential threats
-when the threat has passed, your alarm system shuts off can you calm down

Anxiety disorders
-anxiety is maladaptive, disrupting everyday activities, moods, and thought processes

Pathological anxiety
-irrational, inside is provoked by perceived threats that are exaggerated or nonexistent, and the response is out of proportion to the actual situation
-Uncontrollable, the person cannot shut off the alarm reaction, even though he or she knows it is unrealistic
-Disruptive, it interferes with relationships, job or academic performance, or everyday activities

What are the anxiety disorders
-general anxiety disorder
– Panic disorder
– Phobias
-Post traumatic stress disorder
-Obsessive compulsive disorder

Generalized anxiety disorder (GAD)
-People with this disorder are constantly tense and anxious, and their anxieties pervasive
-They feel anxious about a wide range of life circumstances, sometimes with little or no apparent justification
-When one source of worry is removed, another quickly moves in to take its place
-Anxiety can be attached to virtually any object or to none at all
-Also known as free floating anxiety

What causes generalized anxiety disorder
-Environmental, psychological, and genetic as well as other biological factors

Panic attack
-A sudden episode of extreme anxiety that rapidly escalates in intensity
-Accompanying the intense, escalating surge of physical arousal are feelings of terror and the belief that one is about to die, go crazy, or completely lose control
-A panic attack typically peaks within 10 minutes of onset and then gradually subsides

Panic disorder
-When panic attacks occur frequently and unexpectedly
-Frequency of panic attacks is highly variable and quite unpredictable

Agoraphobia
-The fear of having a panic attack in a place from which escape would be difficult or impossible
-Afraid to go outside
-People live like prisoners in their own homes

Triple vulnerabilities model Of panic
-this model of panic states that a biological predisposition toward anxiety, a low sense of control over potentially life threatening events, and and over sensitivity to physical sensations combined to make a person vulnerable to panic

Catastrophic cognition theory
-people with panic disorder are not only over sensitive to physical sensations they also tend to catastrophize the meaning of their experience

Phobia
-the persistent and irrational fear of a specific objects, situation, or activity
-In the general population, mild irrational fears that do not significantly interfere with that person’s ability to function are very common
-Many people cope with such fears without being overwhelmed with anxiety
-As long as the fear does not interfere with their daily functioning, they would not be diagnosed with a psychological disorder

Specific phobia
-Also known as simple phobia
-An excessive, intends, an irrational fear of a specific objects, situation, or activity that is actively avoided or endured with marked anxiety

Social phobia or social anxiety disorder
An anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations
-most common psychological disorders
-More prevalent among women than men
-the fear of being embarrassed or failing in public significantly interferes with daily life

Taijin kyofusho
-Affects young Japanese Males
-Several features in common with social phobia including extreme social anxiety and avoidance of social situations
-However the person is not worried about being embarrassed in public
-Rather, reflecting the cultural emphasis of concern for others, the person fears that his appearance or smell, facial expression, or body language will offend, insult, or embarrass other people

Explaining phobias
-classical conditioning
– Operate conditioning
– observational learning
-Biologically prepared to acquire fears of certain animals are situations that were survival threats in human evolutionary history

Post traumatic stress disorder (PTSD)
-A long lasting anxiety disorder that develops in response to an extreme physical or psychological trauma
-extreme traumas are events that produce intense feelings of horror and helplessness such as serious physical injury or threat of injury to yourself or to loved ones
-More than twice as many women as men experience PTSD after exposure to trauma
-This disorder is somewhat unusual in that the source of the disorder is the traumatic event itself rather than a cause that lies within the individual

Symptoms of post traumatic stress disorder
-person frequently recalls the event, replaying it in her mind
-Avoiding stimuli or situations that tend to trigger memories of the experience and undergoes a general numbing of emotional responsiveness
-Increased physical arousal associated with anxiety

Several factors influencing the likelihood of developing post traumatic stress disorder
-Personal or family history of psychological disorders more likely to develop
-Magnitude of the trauma plays an important role
-Undergoing multiple traumas will increase the incidence of this disorder

Obsessive compulsive disorder (OCD)
-An anxiety disorder in which a person’s life is dominated by repetitive thoughts (obsessions) and behaviors (compulsions)
-Many people with this disorder have the irrational belief that failure to perform the ritual action will lead to a catastrophic or disastrous outcome
-Obsession and compulsion do not have to be present at the same time but usually are
-content of OCD tends to me are the particular cultures concerns and beliefs

Obsessions
-repeated, intrusive, uncontrollableThoughts or mental images that cause the person great anxiety and distress
-Have little or no basis in reality and are often far-fetched

Compulsion
-A repair this behavior that a person feels driven to perform
-Typically, ritual behaviors that must be carried out in a certain pattern or sequence
-may be overt physical behaviors (ie repeatedly washing hands) or covert mental behaviors (ie reciting certain phrases to yourself)
– about 3/4 of OCD patients suffer from multiple obsessions and slightly more than 50% report more than one type of compulsion

Explaining OCD disorder
-Biological factors are involved
-Deficiency in norepinephrine and serotonin
-Linked with dysfunction in specific brain areas such as those involved in the fight or flight response, and the frontal lobes which play a key role in our ability to think and plan ahead
-Another brain area involved is the caudate nucleus, which is involved in regulating movements

mood disorders (affective disorders)
-The serious, persistent disturbance in a person’s emotions that causes psychological discomfort, impairs the ability to function, or both
-In quality, intensity and duration, a person’s the motion of state does not seem to reflect what’s going on in his or her life
-“affect” is synonymous with “emotion” or “feelings”

Major depression
-a mood disorder characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness, causing impaired emotional, cognitive, behavioral, and physical functioning

Symptoms of major depression
-Often accompanied by the physical symptoms of anxiety
-Some experience a sense of physical restlessness or nervousness, demonstrated by fidgeting or aimless pacing
-Suicide is a potential risk
-Stocks become globally pessimistic and negative about the self, the world, and the future
-Suicide rates range from 7 to 22%
-Abnormal sleep patterns
-To be diagnosed with major depression, a person must display most of the symptoms described for two weeks or longer.
-In many cases, there does not seem to be any external reason for the persistent feeling of depression
-In other cases, a person’s downward emotional spiral has been triggered by a negative life event, stressful situation, or chronic stress

Seasonal affective disorder (SAD)
-Repeated episodes of major depression which most common during autumn and winter when there is the least amount of sunlight
-Subside during the spring and summer

dysthymic disorder
-a less severe form of depression
-A mood disorder involving chronic, low grade feelings of depression that produce subjective discomforts but do not seriously impair the ability to function
-Usually develops in response to some stressful events or trauma
-Rather than improving over time, however, the negative mood persist indefinitely
-Major depression requires symptoms to be present for at least two weeks, while dysthymic disorder requires two years

Prevalence and course of major depression
-in any given year, about 6 to 7% of Americans are affected by major depression
-About 15% of Americans will be affected by major depression at some point in their life
-The woman are about twice as likely as men to be diagnosed
-Research suggests that women are more vulnerable to depression because they experienced a greater degree of chronic stress in daily life come by named with the lesser sense of personal control than men
-Women are also more prone to dwell on their problems
-Many people who experience major depression try to cope with the symptoms without seeking professional help
-When not treated, depression may become a recurring mental disorder that becomes progressively more severe
-More than half of all people who have been through one episode of major depression can expect a relapse, usually within two years
-With each recurrence, the symptoms tend to increase in severity and the time between major depression episodes decreases

Bipolar disorder (manic depression)
-A mood disorder involving periods of incapacitating depression alternating with periods of extreme euphoria and excitement

Manic episodes
-a sudden, rapidly escalating the emotional state characterized by extreme euphoria, excitement, physical energy, and rapid thoughts and speech
-for most people with bipolar disorder, a manic episode immediately proceeds or follows with major depression
-Manic episodes typically begin suddenly, and symptoms escalate rapidly

Symptoms of bipolar disorder
-Although they stayed very little, they have boundless energy
-The person’s self esteem is widely inflated, and he exudes a supreme self confidence
-Often, he has grandiose plans for all of caning wealth, power, and fame
-Sometimes the grandiose ideas represent delusional, or false, beliefs
-Attention is easily distracted by virtually anything, triggering a flight of ideas, in which thoughts were rapidly and loosely shift from topic to topic
-The ability to function during a manic episode is severely impaired and hospitalization is usually required to protect people from the potential consequences of their inappropriate decisions and behaviors
-People can also run up the mountain of bills, disappear for weeks at a time, become sexually promiscuous, or commit illegal acts

cyclothymic disorder
-A mood disorder characterized by moderate but frequent mood swings that are not severe enough to qualify as bipolar disorder
-Can last two years or longer
-People with cyclothymic disorder are perceived as being extremely moody, unpredictable, and inconsistent

Prevalence and course of bipolar disorder
-typically occurs in the person’s early twenties
-Extreme mood swings tend to start and stop much more abruptly than the mood changes of major depression
-Bipolar disorder tends to last much shorter than major depression
-There are no differences between the sexes in the rate at which bipolar disorder occurs on mike major depression
-rarely diagnose in childhood
-In the vast majority of cases, bipolar disorder is a recurring mental disorder -Although they stayed very little, they have boundless energy
-The person’s self esteem is widely inflated, and he exudes a supreme self confidence
-Often, he has grandiose plans for all of caning wealth, power, and fame
-Sometimes the grandiose ideas represent delusional, or false, beliefs
-Attention is easily distracted by virtually anything, triggering a flight of ideas, in which thoughts were rapidly and loosely shift from topic to topic

Treatment of bipolar disorder
-Lithium can control bipolar disorder because it regulates the availability of a neurotransmitter called glutamate
-Glutamate acts as an explanatory neurotransmitter in many brain areas

Explaining mood disorders
Some people inherit a genetic predisposition, or a greater vulnerability, to mood disorders
-Major depression and bipolar disorder tend to run in families
-anti depressants have been developed to treat major depression by increasing the availability of norepinephrine and serotonin in the brain
-Often triggered by a traumatic and stressful events

Eating disorders
-Involve serious and maladaptive disturbances in eating behavior
-Disturbances can include extreme reduction of food intake, severe bouts of overheating, an obsessive concerns about body shape or wait
-Two main types are anorexia nervosa and bulimia nervosa
-Begins during adolescence or early adulthood
-90 to 95% are female

Anorexia nervosa
-An eating disorder characterized by excessive weight loss, and irrational fear of gaining weight, and distorted body self perception
-The person refuses to maintain a minimally normal body weight
-She denies the seriousness of her weight loss
-In females anorexia nervosa causes absence of menstrual cycles
Severe malnutrition disrupts body chemistry in ways similar to those caused by starvation
-Basal metabolic rate, blood levels of glucose, insolent, and leptin decreases

Bulimia nervosa
-and eating disorder characterized by binges of extreme over keating followed by self induced vomiting, misuse of laxatives, or other in appropriate methods to purge the excessive food and prevent weight gain
-People with bulimia stay within the normal weight range or may even be slightly overweight
-People usually recognize that they have an eating disorder unlike for anorexia
-Like anorexia nervosa, bulimia nervosa can take a serious physical toll on the body

Causes of eating disorders
-both anorexia and bulimia involve decreases in brain activity of the neurotransmitter serotonin
-Eating disorders frequently occur with other psychiatric disorders like depression, substance abuse, personality disorders, and anxiety disorders
-Family interaction patterns may contribute
-western culture attitudes toward thinness and dieting probably also contributes to these disorders today

Personality
-the consistent and enduring patterns of thinking, feeling, and behaving that characterize you as an individual

Personality traits
-Traits that are consistent over time and across situations but can possess a fair degree of flexibility and adaptivess in a psychologically well-adjusted person
-Relatively stable predispositions to behave or react in certain ways
-They reflect different dimensions of your personality

Personality disorder
-Inflexible, maladaptive patterns of thoughts, emotions, behavior, and interpersonal functioning better stable over time and the cross situations, and deviate from the expectations of the individuals culture
-Usually become evident during adolescence or early adulthood
-Behaviors are not restricted to isolated episodes are specific circumstances
-People with personality disorders may not consider their personality characteristics as being problematic which is why they do not often seek help

Paranoid personality disorder
-Pervasive but unwanted distrust and suspiciousness
-Assumes that other people intend to deceive, exploit, or harm them
-People with this personality disorder often misinterpret the innocent comments or actions of others
-They are distrustful of people who are close to them, even when there is no evidence to support their suspicious beliefs
-Have a strong tendency to blame others for their own shortcomings

Antisocial personality disorder
-A personality disorder characterized by a pervasive pattern of disregarding in violating the rights of others
-Such individuals are often referred to as psychopaths or sociopaths
-Often lies, cheats, steals, and manipulates other people and when caught, the person shows little or no remorse for having caused the damage
-Person has no conscience or sense of guilt
-Individuals have a relative lack of anxiety
-Evidence is often seen in childhood or early adolescence
-Often hard to treat because clients manipulate and lied to the therapists
-But middle to late adulthood, the antisocial tendencies of such individuals tend to diminish

Borderline personality disorder
-A personality disorder characterized by instability of interpersonal relationships, self image, and emotions, and marked impulsivity
-Moods and emotions are intense, fluctuating, and extreme, often vastly out of proportion to the triggering incident, and seemingly uncontrollable
-The person has a chronic, pervasive sense of emptiness and is desperately afraid of abandonment and alternately clings to others and pushes them away
-She sees herself, and everyone else, as absolutes
-Often considered to be the most serious and disabling of the personality disorders
-People with this disorder often also suffer from depression, substance abuse, and eating disorders
-This is also the most commonly diagnosed

What causes borderline personality disorder
-A disruption in attachment relationships in early childhood
-Dysfunctional family relationships
-The Bio social developmental theory of borderline personality disorder says that this disorder is the outcome of a unique combination of biological, psychological, and environmental factors

Dissociative experience
-It break or disruption in consciousness during which awareness, memory, and personal identity become separated or divided
-For example, you read a book or watch a movie and lose all track of time

Dissociative Disorders
-A category of psychological disorders in which extreme and frequent disruptions of awareness, Manley, and personal identity impair the ability to function
-Identity may be lost, confused, or fragmented

Dissociative amnesia
-The partial or total inability to recall important information that is not due to a medical condition, such as an illness, an injury, or a drug
-Usually the person develops unusual for personal events and information, rather than for general knowledge or skills
-In most cases, this is a response to stress, trauma, or an extremely distressing situation, such as combat, marital problems, or physical abuse

Dissociative fugue
-A dissociative disorder involving sudden and unexpected travel away from home, extensive amnesia, and identity confusion
-The person outwardly appears completely normal
-In some cases, people in a fugue state adopt a completely new identity
-Thought to be associated with traumatic events or stressful periods

Dissociative Identity Disorder (DID) or Multiple Personality Disorders
-a dissociative disorder involving extensive memory disruptions along with the presence of two or more distinct identity for, or personalities
-Typically, each personality has its own name and is experienced as if it has its own personal history and self image
-These alternate personalities may be widely varying in age and gender
-The altar is seem to embody different aspects of the individuals personality that, for some reason, cannot be integrated into the primary personality
-The primary personality is unaware of the existence of the alternate personalities may have knowledge of each other’s existence and share memories

Symptoms of multiple personality disorders
-amnesia and memory problems are reported in virtually all cases
-They lose time and are unable to recall their behaviors for whereabouts during specific time periods
-Symptoms of major depression, anxiety, posttraumatic stress disorder, substance abuse, sleep disorders, and self destructive behavior are very common

Explaining dissociative identity disorder
-many report having suffered extreme physical or sexual abuse in childhood
-Over time, alternative personalities are created to deal with the memories and emotions associated with intolerably painful experiences
-dissociation becomes a pathological defense mechanism that the person uses to cope with overwhelming experiences
-One issue with the coping three is that memories of childhood are notoriously unreliable especially when patients are diagnosed in adulthood
-Also a problem with the traumatic memory explanation is that most victims have recurring and intrusive memories of the traumatic event

Schizophrenia
-A psychological disorder that involve severely distorted beliefs, perceptions, and thought processes
-People become engulfed in an entirely different inner world, one that is often categorized by mental chaos, disorientation, and frustration
-Schizophrenia is diagnosed when two or more positive or negative characteristic symptoms are actively present for a month or longer

Positive symptoms of schizophrenia
-Symptoms that reflect an excess or distortion of normal functioning
-Include delusions or false beliefs, hallucinations or false perceptions, and severely disorganized thought processes, speech, and behavior

Delusion
-A false belief that persists despite compelling contradictory evidence
-beliefs are bizarre and farfetched notions. For example, believing that secret agents are poisoning his food.
-The delusional person often becomes preoccupied with his erroneous beliefs and ignores any evidence to contradicts them
-delusions are often so convincing that they can provoke inappropriate or bizarre behavior like hurting oneself or attacking others

Delusions of reference
-Reflects the person’s false conviction that other people’s behavior an ordinary events are somehow personally related to her
-For example, thinking that billboards and advertisements or about her or they contain cryptic messages directed at her

Delusions of grandeur
-The belief that the person is extremely powerful, important, or wealthy

The lesions of persecution
-The basic theme is that others are plotting against or trying to harm the person or someone close to her

Delusions of being controlled
-Belief that outside forces like aliens, the government, or random people, are trying to exert control on individual

Hallucinations
-False or distorted perceptions, usually voices or visual stimuli, that seem visibly a real
-The content of hallucinations is often tied to the person’s delusional beliefs
-The content of hallucinations and allusions may also be influenced by cultural and religious beliefs

Negative symptoms of schizophrenia
-Symptoms reflect an absence or reduction of normal functions
-Include greatly reduced motivation, emotional expressiveness, or speech

Flat affect or affective flattening
-the person response in an emotionally flat way, showing a dramatic reduction in emotional responsiveness and facial expressions
-Speeches slow and monotonous, lacking normal focal inflections

alogia
-Greatly reduced production of speech
-Verbal responses are limited to brief, empty comments

avolition
-The inability to initiate or persist in even simple forms of goal director behaviors such as dressing, bathing, or engaging in social activities
-Instead, the person seems to be completely apathetic, sometimes sitting still for hours at a time

Types of schizophrenia
-paranoid, catatonic, and disorganized

Paranoid schizophrenia
-characterized by the presence of delusions, hallucinations, or both
-People show virtually no cognitive impairment, disorganized behavior, or negative symptoms
-Well organized delusional beliefs reflecting persecutory or grandiose ideas
-Frequent auditory hallucinations, usually voices
-Most common type of schizophrenia
-Convinced that others are plotted against them, these people react with extreme distrust of others

Catatonic schizophrenia
-Highly disturbed movements or actions, such as extreme excitement, bizarre postures or grimaces, or being completely immobile
-Imitation of movements of others
-People with this form of schizophrenia will resist direction from others and may also assume rigid postures to resist being moved
-characterized with wavy flexibility where a person can be molded into any position and will hold that position indefinitely
-This type is very rare

Disorganized schizophrenia
-Extremely disorganized behavior, disordered speech, and flat affect
-Fragmented delusional ideas and hallucinations, and shifting themes
-Silliness, laughing, and giggling may occur for no apparent reason

Undifferentiated schizophrenia
-used when an individual displays some combination of positive and negative symptoms that does not clearly fit the criteria for the paranoid, catatonic, or disorganized types

Prevalence and course of schizophrenia
-onset typically occurs during young adulthood
-For Males, usually occurs between 16 and 20 years of age. If he does not show any signs of schizophrenia after 25, he will not have it.
-For females, usually occurs from 25 to 35 years of age. If signs do not show until after 35, it is not schizophrenia.
-About one out of four people who experience an episode of schizophrenia recover completely and never experienced another episode.
-Another one of four experience recurrent episodes of schizophrenia but often with only minimal impairment in the ability to function
-About ½ of the total schizophrenia patients become a chronic mental illness and the ability to function may be severely impaired

Explaining schizophrenia
-genetic factors play a significant role in many cases
-new cases of schizophrenia arise from genetic mutations carried in the sperm of the biological fathers, especially older fathers
-Schizophrenia might be caused by exposure to an influenza virus or other viral infection during prenatal development or shortly after birth. Trojan whose mothers were exposed to a flu virus during pregnancy, especially during the first or second trimester, showed an increase in rate of schizophrenia
-People with schizophrenia have enlarged ventricles located deep within the brain
-Dysfunctional parenting, disturbed family communication styles, and critical or guilt – inducing parental styles are also possible contributors to schizophrenia

Dopamine hypothesis
-According to this hypothesis, schizophrenia is related to excessive activity of the neurotransmitter dopamine in the brain
-Antipsychotic drugs that reduce or block dopamine activity in the brain also reduce schizophrenic symptoms, especially positive symptoms, in many people
-Drugs that enhance dopamine activity in the brain, such as amphetamines and cocaine, can produce schizophrenia – like symptoms in normal adults or increase symptoms in people who already have schizophrenia

Who commit suicide
-About twice as many Americans die each year from suicide as from homicide
-30,000 people per year take their own lives in the United States
-500,000 people require emergency room treatment as a result of attempted suicide
-Woman outnumber men by 3 to 1 and the number of suicide attempts
-Men outnumber women by more than 4 to 1 in suicide deaths, primarily due to the use of more lethal methods
-A myth is that more suicides occur during the winter holidays. In the United States, suicide rates are actually the lowest during the winter months and the highest in the spring.

How can you help prevent suicide
1. Actively listen as the person talks and vents her feelings.
2. Don’t deny or minimize the person’s suicidal intentions
3. Identify other potential solutions.
4. Ask the person to delay his decision
5. Encourage the person to seek professional help

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