Psychological Disorders 45% have been diagnosed once in their lifetime

Class Question What comes to mind when you hear the term psychological disorder? What is a Psychological Disorder? Hard to pin down a correct definition o Baron (definition)- thought and behavior that is maladaptive and causes the individual distress o Abnormal - deviates from the norm being left handed is considered abnormal, does not fit definition? o Maladaptive - behavior is disruptive thinking interferes with functioning o Personal distress-personality disorders serial killers (antisocial disorders) What is a Psychological Disorder? APA definition acknowledge that it can be due to learning, thought processes etc o A pattern of behavior can be considered a psychological disorder if it satisfies three conditions: o The person experiences significant pain or distress, an inability to work or play, an increased risk of death, or a loss of freedom in important areas of life. o The source of the problem resides within the person, due to biological factors, learned habits, or mental processes, and is not simply a normal response to specific life events such as the death of a loved one. o The problem is not a deliberate reaction to conditions such as poverty, prejudice, government policy, or other conflicts with society. People in Egypt who are protesting are not considered to have a disorder just because their behavior deviates from norm One year prevalence rates o 26.2% of adults suffer from a diagnosable disorder each year Any anxiety disorder 18.1% Any mood disorder 9.5%(predominantly depression, followed by bipolar Schizophrenia 1.1% o Source: Kessler et al. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):61727. o Surveys are taken to find out these figs as a lot of people avoid treatment One year prevalence rates for children (under 18) o 20.9% of children have any disorder in a given year Anxiety 13.0% Mood disorders 6.2% Disruptive disorders 10.3% behavioral, Substance abuse 2.0% o Source: Surgeon Generals report on Mental Illness (1999)

Explaining Psychological Disorders - Why do people develop psychological disorders? o Chemical imbalances o Early childhood experiences- impacts how you think about the world o Environmental factors, e.g., stress o Distorted thought processes o Genetics Biological approach o Abnormal behavior results from some physical dysfunction o Physical deformity that produces this disorder-dysfunction in brain, genetic abnormality disease of the brain Psychological approaches o Psychological disorders are the result of past and present life experiences Psychodynamic - intrapsychic conflict idea of conflicts between id, ego and superego Behavioral - abnormal behavior is learned- john Watson and albert. Reinforced for certain behaviors Cognitive - distorted thinking how we think about the world, ourselves Sociocultural approach o Psychological disorders occur within the context of society o Highlight the importance of society on how we express behavior (eating disorders and fashion) o Teenagers and different cultures. When American teenagers are unhappy they act out- drugs etc. In Thailand teenagers sleep, are antisocial. o Koro irrational fear that your genitals might get sucked back into the body and you would die. Pibloktoq- Inuit- arctic hysteria- seizure type behavior- eat feces, abuse, wake up later with no recollection about what they did Incidence Rates of Common Psychological Disorders Types of disorder Men Women Anxiety 19% 31% due to te culture and society we live in Depression 15% 24% Substance Abuse 35% 18% Schizophrenia (no gender diff) 0.6% 0.8% Antisocial Personality 6% 1% Source: Kessler et al. (1994) Gender differences in diagnoses o Women are taught to express emotions, men are supposed to remain stoic o Differences in power- fear of rape at 3 am in the morning, fear about personal safety is more for women. Pay etc Mental illness as a myth

o Thomas Szaz - problems in living not mental illness- To call behavior a disease is wrong. What we perceive as psych. Disorders is just fallacies in society. We use it to ignore people we dont like. o Ex people who opposed the soviet gov were put in psych. facilities Interactionist approach-what causes abnormal behavior o Diathesis-stress model- the argument that a person may have a tendency towards from some disorder. But this biological cause is not enough, needs an environmental trigger/stressor to activate the disorder. It is expanded to include all factors o Biopsychosocial model there are bio, social and psych causes that work together. Broader approach, children who experience trauma are more likely to experience PTSD if put into a war zone. PTSD due to their childhood experience. There might be childhood experiences that also protect you from developing a disorder in the future. How do we treat psychological disorders? o Treatment based on concept of the disorder Trephining-drilling holes into the skull to release spirits trapped inside the head that causes disorders. Greeks believed that if you had too much of a certain body fluid, it would cause you to act abnormally. Dark ages people believed in devil possession ergo burning at the stake. St. Marys of Bethlehem- (famous renaissance asylum in England) emergence of the asylum to imprison crazy people Phillipe Pinel superintendent at an asylum in Paris. Unchained the inmates. Believed in moral therapy that if you gave patients good work, it would help them Biomedical therapies o Psychosurgery- Remove/destroy a portion of the brain- frontal lobotomy to treat disturbing behavior as it worked in primates. One of the more significant treatments at the time o Freeman ice pick lobotomy. Lobotomy went out of fashion when drugs were discovered o Electroconvulsive therapy-application of electric shocks to create seizures. Doctors thought that seizures were prophylactic against schizophrenia. Seletti- had a patient who was mute and had catatonia. Induced seizure on person who spoke after treatment. Is used as a treatment for depression as a fast and effective treatment o Drug therapies. Drugs alleviate symptoms they dont cure disorders The nature of psychotherapy

o Psychotherapy - a form of treatment in which a trained professional employs psychological techniques to help persons in need Insight therapy-trying to gain understanding about their problematic behavior. If I get an insight into the cause, I will get better. Behavior therapy-does not care about finding the cause. Change behavior (give punishments etc) to change the disorder. Eclectic - using more than one approach-elements of exploring childhood experiences, current experiences and life skills to treat the person. Psychodynamic therapies o Psychoanalysis (Freud) Idea that childhood experience affects later life.goal is insight and catharsis-to help make the unconscious conscious and allow mental relief. Free association- let the individual talk about what is on their mind to help them come to a conclusion Resistance- once they are close to realizing the cause, the patient starts missing sessions, avoiding the topic; is resistant to admitting the cause. Transference- Patients developed strong feelings toward therapist, a reenactment of significant relationships that happened in the patients life. Ex maternal relationship of critical nature is transferred between the patient and therapist Contemporary psychodynamic therapiesHumanistic therapies-distress cause as we are not living up to our ideal self. Goal is self actualization o Person-centered therapies-pioneered by Carl Rodgers-goal being to help validate the patient o Empathy-the therapist expresses an understanding as to what the client is feeling, shows empathy towards patient. o Unconditional positive regard- the therapist communicates through their posture, actions that they are good humans whose actions have cause people pain but are good under all those actions o Active listening and genuineness (congruence)- in odds with psychodynamic approach. Rodgers felt that you should have reactions towards patients declarations. Behavior therapies-very effective for anxiety disorders o Classical conditioning approaches John Watson, Albert- use this idea to remove fear Counterconditioning- reward for approaching the fear Systematic desensitization -Joseph Wolpe teach people how to relax the muscles of the body and introduce them to gradual increase in their fear stimulus (mary, peter and the rabbit). Ex afraid of spiders- show a picture of a spider, keep calm and work al the way up to introducing a spider while you remain calm.

Aversion therapy-training people to become afraid/ anxious around a previously pleasurable stimulus. Ex smoking- every time he smokes, you administer an electric shock. o Operant conditioning approaches-reward and punishment to reduce the particular behavior Token economies- reward for enforcing a particular positive behavior. Developed in psychiatric institutions for patients. Rward social behavior with a snack, etc Punishment- not usually effective- has to be implemented regularly Self mutilation- people who bang their head against the wall, administering an electric shock (punishment) could reduce this behavior Flooding/Exposure- overwhelm the patient with their fear and not let them escape (to avoid the pleasure felt when you escape your fear). Seems to be a cruel method of o Social learning- therapist models the behavior and asks the patient to repeat it. Therapist holds the spider, proves it is harmless and asks the patient to do the same. Cognitive therapies o Psychological disorders are caused by distorted thoughts o Change the thoughts and cure the disorder Managed care. Goal-to control costs o Favors short-term treatment-stops after feel that you have had enough. Focused intervention, goal is to get them back to the world asap. Loss of confidentiality o Lack of confidentiality- therapist needs to get authorization from insurance company to continue treatment. You have to talk about the patient to validate continuity of treatment o Oversight eats up savings- therapists, doctors spend a lot of time talking to the insurance company and a lot of money and time. Uw hospital spent $15000 just to interact with insurance companies. The variety of health care professionals o Clinical Psychologist- people who have a graduate degree and have a major understanding of psych. Cannot prescribe o Psychiatrist-gone to med school can dispense medications. o Counseling Psychologist o Social Worker o Psychiatric Nurse o Occupational Therapist o Pastoral Counselor-rabbi, minister o Counselor Is therapy effective? o Consumer Reports study Good rep for testing prod. Did a bad study. 80% said that psychotherapy was beneficial.

o Hans Eysenck (1952) review treatment lit where peole are assigned to therapy/ non thery cond- 2/3 got better and 2/3 without therapy also got better. Therefor no conclusion. NEGS-Some had no random assignment. Other studies did not make sure that people in no trstment did not get other forms of trstment ex meds o Mary Lee Smith (1980) review 480 studies- found that the average psychotherapy patient shows more than 80% improvement and better fucnt than people who dont get therapy at all. No one particular therapy that was most effective. All were effective to a certain degree. But certain therapies were more effective in dealing with a particular disorder than others o Kenneth Howard (1996)- looked at # of sessions individual got and the likelihood of improvement. Positively correlated Common themes of successful psychotherapy no approach is consistently better o Supportive relationship - empathy and warmth b/w therapist and patient. Associated with clinical improvement. Not dependent on particular type of therapy given. Clients who feel that they are understood by therapist improve. o Ray of hope-maybe things can change. Gives a push that helps you make changes; motivates you. o Opportunity to open up-let their feelings out. Classifying Psychological Disorders DSM IV diagnostic and statistical Introduced in1952. More specific about different criteria for disorders. Course, diagnosis, treatment. Multi axial diagnostic system o Axis I: primary diagnosis of the disorder-behavioral, psych disturbance interfering with funct o Axis II: personality disorder and mental retardation-long standing or chronic disfunct- personality disorders, something that affects the primary disorder o Axis III: medical conditions that might effect the individuals psychological disorder-if the person had had a stroke that plays a role in their disorder o Axis IV: recent social and environmental sources of stress in the persons life envi, social stress that make the disorder worse or is a causative agent o Axis V: current level of functioning and highest level of functioning in the past year- how impaired the individ is, can they go to work and what was thaier highest level of functiionnign Criticisms of DSM-IV o Reinforces disease model-dsm reinforces disorders as diseases- there is something biologically wrong with you. o Everyday problems viewed as mental problems-classifies everyday things as pathological. o Overly responsive to political issues-changing diagnosis in response to political power. Not arbitrary, influence by the norms of the time. DSM 3 there was a new disorder describing PMS as a mood disorder.

o Power of the label-whole way in which we see an individ as their diagnosis the diagnosis becomes the person Rosenhan study 1960s got admitted to psych hospitals saying they had auditory hallucination. As soon as they got admitted they stopped reportig tat syptoms. How long it took for the institi. To declare them ok. Logest period was 8wks. Theroises that once a person was dagnosed and Lablled they stopped being human. Am. Psychiatric Assoc. - label behavior not person rather than I am a schizo, I am a person with scizo.