ࡱ> fhe>bjbj .j6aaaaauuuu4|uP(l%:____:::'''''''$)^,d'a::'aa__ ("""a_a_'"'"""'_dub'' (0P(',B!<,',a'(:0j"":::''~"::::P(,::::::::: ':INTRODUCTION TO PSYCHOLOGY Chapter 16 Psychopathology At the end of this Chapter you should be able to: Learn about Psychodynamic approach Learn different conceptions of Mental Disorder Difference between psychosis and neurosis Psychodynamic approach Defense Mechanisms Learn about Schizophrenia Learn about Mood Disorders Learn about Anxiety Disorders Learn about Dissociative Disorders History of Mental Illnesses The psychodynamic approach: Probing the depths Examines motives underlying our behavior Motives can be conscious But Motives may also be poorly understood May be completely hidden from our own view/comprehension Models of mind Levels of processing: Conscious: currently being thought about Preconscious: easily available to us Unconscious: unavailable to our (willed) thought Structures of personality: Id Ego Super-ego Structures of Personality Id: all other aspects of personality emerge from this basic, primitive, pleasure seeking part of our personality Ego: deals with reality and its demands; copes with demands from Id and Superego: societys rules and parents rules, internalized and imposed on the ego Conflict and defense Interplay of the three structures and the three levels of processing: the dynamics of this theory Avoiding anxiety is prime directive Defense mechanisms are in place to protect the personality from anxiety that may feel overwhelming Defense mechanisms Repression: Keeping distressing thoughts & feelings buried in the unconscious Example: A child who witnessed a parent being shot has no recollection of the event. Denial: Refusing to recognize some anxiety arousing event/piece of information. Example: although her husband keeps beating her, his wife doesnt accept it. Rationalization: Creating false but plausible excuses to justify unacceptable behavior Example: A student watches TV instead of studying, claiming "additional studying wont help anyway". Displacement: Diverting emotional feelings from their original course to a safer substitute target. Example: After getting a speeding ticket you take your anger out on your passenger rather than the state trooper. Reaction Formation: Behaving in a way that is exactly opposite of ones true feelings Example: A parent who unconsciously resents a child spoiling that child with lavish gifts. Projection: Attributing ones own thoughts, feelings or desires to someone else Example: Deep down you hate your brother (but are unaware of this) - instead you feel your brother hates you. Regression: Reverting to immature patterns of behavior. Example: A six year old renews his thumb-sucking when a new sibling is born. MENTAL ILLNESSES PSYCOPATHOLOGY Normal versus Abnormal Concept of abnormal not sufficient or necessary to be mentally disordered - It is not normal to be very joyous, but this mental state, while not normal, is not mentally ill either On the other hand It is normal to have cavities in teeth occasionally, but doesnt mean thats healthy / preferred The term normal therefore is very problematic The modern conception of mental disorder What best explains the cause, or source, of mental disorders? Psychological sources Biological sources Learning sources all contribute important explanatory power Diathesis-Stress Models Two factor model An event + a diathesis Event occurs which is stressful Combines with a genetic, biological, or other structural/physical factor When both occur, depression, for example, may result Helps address why some identical events do not produce same outcome in different people Classification Neurosis vs Psychosis Neurosis A term no longer used medically Diagnosis for a relatively mild mental or emotional disorder that may involve anxiety or phobias but does not involve losing touch with reality. Neurosis A neurotic disorder can be any mental imbalance that causes or results in distress. In general, neurotic conditions do not impair or interfere with normal day to day functions, but rather create the very common symptoms of depression, anxiety, or stress. It is believed that most people suffer from some sort of neurosis as a part of human nature. Neurosis One with a neurosis is aware of his disorder Can differentiate between what is real and what is not Types of Neurosis According to DSM classificationthere are four types of Neurosis: Anxiety Disorders Panic attacks Phobias Obsessive Compulsive Generalized Anxiety Post Traumatic Stress Disorders Somatoform Disorders Conversion Disorders Hipocondria Dissociative Disorders Dissociative Amnesia Dissociative Identity Disorder Mood Disorders Depression Anxiety Disorders Mood here is anxiety Overwhelming feelings of fear/ anxiety/ apprehension and incomplete or unsuccessful attempts to deal with this Most common clinical diagnosis Found in both genders; but, higher prevalence overall in women compared to men Phobias Social phobia: fear of public scrutiny or public judgment, emerges most commonly in adolescence Avoid many common social/public experiences Common to use/abuse substances to manage fear Specific phobia: irrational fear of some object, situation, event: bridges, heights, spiders Panic disorder and agoraphobia Panic attacks: sudden onset of full fight/flight symptoms, including feelings of choking, dizziness, lightheadedness heart pounding, sweating, dread, need to run or escape Panic attacks not uncommon in general public! In panic disorder, one experiences panic attacks either out of the blue, or unpredictably in response to certain stressors/events Attempts to avoid any further panic attacks are hallmark of the disorder the fear of fear Over time, increased attention to symptoms develops; this increases number of attacks Agoraphobia then may result Generalized Anxiety Disorder Continuous anxious feeling No real trigger; trivial worries can intensify Symptoms: constant sense of dread; gut/intestinal upset; inability to focus; increased heart rate; excessive sweating; constant worry Common disorder; around 3% of population Obsessive-Compulsive Disorder Obsessions: unwanted, intrusive thoughts (If I step on this crack I will cause my mother to die) Compulsions: irresistible urges to engage in certain behaviors (I must repeat this phrase 20 times to keep my mother from dying) Usually, thoughts increase anxiety; compulsions feel as though they will directly decrease the anxiety Typically, compulsions decrease anxiety only temporarily Predispositions for OCD? Again, genetic: CR higher for identical than fraternal twins Separate inheritance paths for different types of OCD: e.g., cleaning may be uniquely transmitted, but not other forms (checking or washing) Stress disorders Occur in response to events that threatened ones life directly, or threatened integrity of ones life (or someone elses life) Often marked by acute feelings of distance/estrangement from dissociation Alternates with intense reliving of the event: nightmares, flashbacks, intrusive thoughts Post-traumatic stress disorder Diagnosed only after one month has passed Other symptoms: increased startle reflex, inability to focus/concentrate; problems with memory and attention; intense irritability; avoidance of memories of event; continued problems with flashbacks and nightmares However of those who experience trauma, only about 5 12% develop PTSD Better prognosis if Trauma less severe Preparation or training was in place (so, police and firefighters trained to deal with frightening situations less likely to develop PTSD than ordinary citizens facing same situation) Better social support prior to trauma No adverse/traumatic experiences in childhood Lack of PTSD in parents background Dissociative Disorders Dissociation: distancing of the self from what is occurring; dissociation between an on-going event from ones sense that one is experiencing it; sense of watching from a distance As a defense mechanism: effective in many ways Over the long term: dissociation associated with poorer outcomes This response is the defining feature of dissociative disorders Dissociative disorders Dissociative amnesia Inability to remember discrete period of ones life, ones identity, aspects of ones biography Or One wanders away from home for a time, then suddenly comes back to ones senses with no memory for that period of time Dissociative identity disorder Two or more distinct personalities can be identified or take action in ones life Can differ by gender, age, SES, interests, etc. Controversial diagnosis; given with caution Factors underlying Dissociative Disorders: Ability to dissociate: trait aspects, some easily able to dissociate, others unable to dissociate Intense/abusive/traumatic stress as a trigger? Somatoform Disorders Hypochondriasis: Hypochondriasis is preoccupation with the fear of having, or with the idea that one has, a serious disease, based on misinterpretation of nonpathologic physical symptoms or normal bodily functions Treatment is difficult because patients believe that something is seriously wrong and that the physician has failed to find the real cause. Psychosis As a psychiatric term, psychosis refers to any mental state that impairs thought, perception, and judgement. A psychotic person loses contact with reality and experiences hallucinations or delusions. Psychosis The three primary causes of psychosis are: Functional (mental illnesses such as schizophrenia and bipolar disorder), Organic (stemming from medical, non-psychological conditions, such as brain tumors or sleep deprivation) Psychoactive drugs (eg barbituates, amphetamines, and hallucinogens). HYPERLINK "sizofreni_ornek_6dak.asx"Schizophrenia Abnormal disintegration of mental functions Eugene Bleuler Problematic description; term still used 1-2% of population exhibits this disorder Higher (or lower) in many populations; variations not well understood Usual onset: late adolescence/early adulthood Signs/Symptoms Positive symptoms (too much of something) Delusions (fixed idea or belief, obviously untrue or unlikely) Hallucinations (seeing or hearing something others dont) Disorganized speech/behaviors Negative symptoms (not enough of something) Blunted/limited emotion Poverty of speech Poverty of language Unable to persist in tasks Other symptoms Pronounced social withdrawal May begin at a very young age, well before other symptoms Idiosyncratic inner world extremely difficult for others to access / understand Difficulty communicating all seem to result in less social contact and fewer friends as years go by The roots of schizophrenia Heredity/genetics: Examined by looking at concordance rates, Ex: Consider 100 families, all of whom have identical twins; one twin of each pair of twins has schizophrenia -- the concordance rate tells us how many of the co-twins have it as well -- Identical twins CR: up to 50% -- Fraternal twins CR: about 25% -- Sibling CR: about 8% As genetic overlap increases, rates of schizophrenia increase Prenatal environment Why is CR not 100%? Environment plays an important role; environment is not identical even if genetic material is identical Birth complications? Viral exposure? Time of birth (i.e., season)? Many environmental factors point to schizophrenia being a neurodevelopmental disorder Social and Psychological Environment Stressors from much later in life ( may play a role Stress from poverty, racism, poor/absent education Parent or parents who also suffer from mental disorder Psychotic Mood Disorders HYPERLINK "mania_depression.asx"Bipolar and Unipolar Each pole: a different mood state At manic pole: feelings of ease, intensity, power, well-being, financial omnipotence and euphoria (Kay Redfield Jamison, 1995, p. 67) Hypomania: milder form of mania; hard to sustain Mania: unable to function, loss of ones ability to maintain rationality, or to complete goal-directed activity, fear/paranoia set in. At the other pole HYPERLINK "DepressionTheoriesandTreatments.mpg"Depressive states: Guilt, shame, dread Hopelessness, loss of interest and pleasure in life Sleeping / eating problems (too little or too much) Thoughts of death, dying, suicide; plans or attempts or completed suicide Alternating between Mania and Depression: Bipolar Disorder (from one pole to the other) The roots of mood disorders Heredity Concordance rates (CR) for Depression: 2x higher in identical twins compared to fraternal twins CR for Bipolar Disorder: Identical twins, CR = 60%; fraternal twins, CR = 12% Risk for other aspects (suicide, other forms of depression) increases as genetic overlap increases Case Study 1 34 year old, male Talks to himself loudly Lives in the streets, doesnt have any relatives Does not take care of himself / does not clean himself, dirty Looks, talks and laughs at things that does not exist Can not identify reality Sees hallucinations His interpersonal relations are very weak Case Study 1 What is the diagnosis? PSYCHOTIC? NEUROTIC? Case Study 1 Probable diagnosis would be; PSYCHOTIC SCHIZOPHRENIA Case Study 2 27 years old, female, housewife Very captious since childhood Married 6 years ago, has 2 daughters Constantly cleans the house Whenever guests leave the house, she cleans the house for hours Life becomes unbearable for her family Stays in the bathroom for at least 2 hours, finishing one block of soap Case Study 2 She says I know what I am doing is ridiculous, but I cant help it Her relations with people other than her family, are very positive Admits she has a disorder, goes and asks for help from a doctor, willingly Doesnt lose contact with reality Uses reaction formation and rationalization as defence mechanisms to avoid from anxiety Case Study 2 What is the diagnosis? PSYCHOTIC? NEUROTIC? 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