心理衛(wèi)生學(xué)ppt課件

1、Chapter 14Psychological DisordersAbnormal Behavior: Concepts and ControversiesLEARNING OBJECTIVESDescribe and evaluate the medical model of abnormal behavior.Identify the most commonly used criteria of abnormality.Describe the five axes of the DSM-IV and controversies surrounding the DSM-IV system.S

2、ummarize data on the prevalence of various psychological disorders.Abnormal Behavior, continuedThe medical model applied to abnormal behaviorThe medical model “proposes that it is useful to think of abnormal behavior as a disease and has become the main way of thinking about mental illness today.Thi

3、s view is in stark contrast to how mental illness used to be perceived (see Figure 14.1).Thus, the medical model has brought much needed improvement in patient care.Figure 14.1. Historical conceptions of mental illness. Throughout most of history, psychological disorders were thought to be caused by

4、 demonic possession, and the mentally ill were candidates for chains and torture.The medical model, continued Diagnosis “involves distinguishing one illness from another. Etiology “refers to the apparent causation and developmental history of an illness. Prognosis “is a forecast about the probable c

5、ourse of an illness.Abnormal Behavior, continuedCriteria of Abnormal Behavior Deviance the behavior must be significantly different from what society deems acceptable. Maladaptive behavior the behavior interferes with the persons ability to function. Personal distress the behavior is troubling to th

6、e individual.Psychodiagnosis: The Classification of DisordersThe American Psychological Association (A.P.A.) uses the Diagnostic and Statistical Manual (now in its fourth revision and referred to as the DSM-IV) to classify disorders.It provides detailed information about various mental illnesses tha

7、t allows clinicians to make more consistent diagnoses.Classification of Disorders, continued Controversies surrounding the DSMSome argue thatThe categorical approach to pathology should be replaced by a dimensional approach.The DSM “medicalizes everyday problems into disorders.e.g. difficulty contro

8、lling gambling becomes “pathological gambling disorder. Prevalence of Psychological DisordersEpidemiology is “the study of the distribution of mental or physical disorders in a population.Prevalence “refers to the percentage of the population that exhibits a disorder during a specified time period.R

9、esearch suggests that there has been a real increase in the prevalence in disorder (see Figure 14.4).The most common classes are substance use, anxiety, and mood disorders.Figure 14.4. Lifetime prevalence of psychological disorders. The estimated percentage of people who have, at any time in their l

10、ife, suffered from one of four types of psychological disorders or from a disorder of any kind (top bar) is shown here. Prevalence estimates vary somewhat from one study to the next, depending on the exact methods used in sampling and assessment. The estimates shown here are based on pooling data fr

11、om Wave 1 and 2 of the Epidemiological Catchment Area studies and the National Comorbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000). These studies, which collectively evaluated over 28,000 subjects, provide the best data to date on the prevalence of mental

12、illness in the United States.Anxiety DisordersLEARNING OBJECTIVESList and describe four types of anxiety disorders.Discuss the contribution of biological factors and conditioning to the etiology of anxiety disorders.Explain the contribution of cognitive factors and stress to the etiology of anxiety

13、disorders.Anxiety Disorders, continued Anxiety disorders “are a class of disorders marked by feelings of excessive apprehension and anxiety.Generalized anxiety disorder “is marked by a chronic, high level of anxiety that is not tied to any specific threat.Phobic disorder “is marked by a persistent a

14、nd irrational fear of an object of situation that presents no realistic danger.Anxiety Disorders, continued Panic disorder “is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly (see following animation sequence).Insert Video: “Panic Disorder: Sym

15、ptoms. From CDROM CB 9th editionAgoraphobia “is a fear of going out to public places.Agoraphobia may result from severe panic disorder, in which people “hide in their homes out of fear of the outside world.Anxiety Disorders, continued Obsessive-compulsive disorder (OCD) “is marked by persistent, unc

16、ontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).Common obsessions include fear of contamination, harming others, suicide, or sexual acts.Compulsions are highly ritualistic acts that temporarily reduce anxiety brought on by obsessions.An

17、xiety Disorders, continued Obsessive -compulsive disorder, continuedOCD disorders occur in approximately 2.5% of the population.Most cases of OCD emerge before the age of 35.Anxiety Disorders, continued Etiology of anxiety disordersBiological factorsInherited temperament may be a risk factor for anx

18、iety disorders.“Anxiety sensitivity theory posits that some people are more sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur.Anxiety Disorders, continued Etiology of anxiety disorders, continuedThe brains neurotransmitters, or “chemicals that carry sign

19、als from one neuron to another, may underlie anxiety.In particular, drugs that affect the neurotransmitter GABA (e.g., Valium) suggest that these chemical circuits may be involved in anxiety disorders.Anxiety Disorders, continued Etiology of anxiety disorders, continuedConditioning and learningClass

20、ical conditioning may cause one to fear a particular object or scenario.Then, avoiding the fear stimulus is negatively reinforced, through operant conditioning, by making the person feel less anxious.Seligman (1971) adds we are “biologically prepared to fear some things more than others, however.Anx

21、iety Disorders, continued Etiology of anxiety disorders, continuedCognitive factorsSome people are more likely to experience anxiety disorders because theyMisinterpret harmless situations as threatening.Focus excess attention on perceived threats.Selectively recall information that seems threatening

22、.Anxiety Disorders, continued Etiology of anxiety disorders, continuedStress as a factorFinally, anxiety disorders may be linked to excessive stress.Specifically, research (Brown, 1998) has found that people with anxiety disorders were more likely to have experienced severe stress one month prior to

23、 the onset of their disorder.Thus, stress may precipitate the onset of anxiety disorders.Somatoform DisordersLEARNING OBJECTIVESDistinguish among the three types of somatoform disorders.Summarize what is known about the causes of somatoform disorders.Somatoform Disorders, continued Somatoform disord

24、ers “are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors.Somatization disorder “is marked by a history of diverse physical complaints that appear to be psychological in origin.It occurs mostly in women.Symptoms seem to be linked to

25、stress.Somatoform Disorders, continued Conversion disorder “is characterized by a significant loss of physical function with no apparent organic basis, usually in a single organ system.Common symptoms includePartial or total loss of vision or hearing.Partial paralysis.Laryngitis or “mutism (inabilit

26、y to speak).Seizures or vomiting.Loss of function in limbs.Somatoform Disorders, continued Hypochondriasis (or hypochondria) “is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses.People with hypochondria are convinced their symptoms

27、 are real and often become frustrated with the medical establishment.Hypochondria often occurs along with anxiety disorders and depression.Somatoform Disorders, continued Etiology of somatoform disordersPersonality factorsSomatoform disorders are more common in people with “histrionic personalities

28、(those who thrive on the attention that illness brings).Neuroticism also seems to elevate ones predisposition to somatoform disorders.Somatoform Disorders, continued Etiology of somatoform disorders, continuedCognitive factorsSome people focus excessive attention on bodily sensations and amplify the

29、m into perceived symptoms of distress.They also have unrealistically high standards of “good health. Thus, any deviation from perfect health is seen as a sign of illness.Somatoform Disorders, continued Etiology of somatoform disorders, continuedThe sick roleSome people learn to “l(fā)ike being sick beca

30、useIt allows one to avoid challenging tasks.Demands arent placed on sick people.It provides an excuse for failure.Being sick elicits attention from others.Dissociative DisordersLEARNING OBJECTIVESDistinguish among the three types of dissociative disorders.Summarize what is known about the causes of

31、dissociative disorders.Dissociative Disorders, continued Dissociative disorders “are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.Dissociative Disorders, continued Dissociative amnesia & fugueDis

32、sociative amnesia “is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting.It often occurs after a single traumatic event or an extended period of severe trauma or stress.Dissociative Disorders, continued Dissociative amnesia & fugue, contin

33、uedDissociative fugue is a disorder in which “people lose their memory for their sense of personal identity.People suffering from this disorder often wander away from home, do not know who they are, where they live, or who they know.Dissociative Disorders, continued Dissociative identity disorder (D

34、ID) “involves the coexistence in one person of two or more largely complete, and usually very different, personalities.Also known as “multiple personality disorder, in which each personality has its own name, memories, traits, and physical mannerisms. Transitions between identities can be sudden and

35、 the differences between them can be extreme (e.g., different races or genders).Dissociative Disorders, continued Etiology of dissociative disordersPsychogenic amnesia and fugue are usually the result of extreme stress.Dissociative identity disorder is a fascinating and bizarre disorder, and its cau

36、ses are largely unknown.However, many clinicians suspect that DID may result from severe emotional trauma that occurs in childhood.Mood DisordersLEARNING OBJECTIVESDescribe the two major mood disorders, and discuss their prevalence.Evaluate the degree to which mood disorders elevate the probability

37、of suicide.Clarify how genetic and neurochemical factors may be related to the development of mood disorders.Mood Disorders, continuedLEARNING OBJECTIVES, continuedDiscuss how cognitive processes may contribute to mood disorders.Outline the role of interpersonal factors and stress in the development

38、 of mood disorders.Mood Disorders, continued Mood disorders “are a class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes.Major depressive disorder is one in which people “show persistent feelings of sadness and despair

39、and a loss of interest in previous sources of pleasure.Onset can occur at any time, but most cases occur before age 40.The majority of people with depression (75-95%) will experience a repeat episode.Mood Disorders, continued Major depressive disorder, continuedDepression is one of the most common m

40、ental illnesses (the lifetime prevalence is 16.2%).However, prevalence is tied to gender. Women are twice as likely to be diagnosed with depression.This does not appear to be tied to biological differences between men and women and could result from greater stress and abuse that women experience.Moo

41、d Disorders, continued Bipolar disorder (once known as manic-depressive disorder) “is marked by the experience of both depressed and manic periods.“Manic periods are characterized by bouts of extreme exuberance and a feeling of invincibility. However, this state of elation alternates, sometimes sudd

42、enly, with periods of depression (see Figure 14.10).Figure 14.10. Common symptoms in manic and depressive episodes. The emotional, cognitive, and motor symptoms exhibited in manic and depressive illnesses are largely the opposite of each other.From Sarason, I.G., & Sarason, B. R. (1987). Abnormal ps

43、ychology: The problem of maladaptive behavior (5th ed., p. 283). Englewood Cliffs, NJ: Prentice-Hall. 1987 Prentice-Hall. Reprinted by permission of Prentice-Hall, Inc. Mood Disorders, continued Mood disorders and suicide90% of people who complete suicide suffer from some type of psychological disor

44、der.Suicide rates are highest for people with mood disorders, who account for 60% of completed suicides.Lifetime risk for those with bipolar disorder is 15-20%; it is 10-15% in those who have had depression.Mood Disorders, continued Etiology of mood disordersGenetic vulnerabilityConcordance rates, o

45、r “the percentage of twin pairs or other pairs of relatives that exhibit the same disorder, suggests there is a genetic basis for mood disorders.Concordance rates for identical twins is 65-72%, whereas it is only 14-19% for fraternal twins who share fewer genes but the same environment.Mood Disorder

46、s, continued Etiology of mood disorders, continuedNeurochemical & neuroanatomical factorsMood disorders are correlated with low levels of two neurotransmitters in the brain:Norepinephrine.Seratonin.However, it is unclear whether changes in these chemicals are the cause, or the result, of the onset o

47、f mood disorders.Mood Disorders, continued Etiology of mood disorders, continuedNeuroanatomical factors, continuedDepression is also correlated with reduced hippocampal volume.The hippocampus, is 8-10% smaller in depressed, than in normal, subjects (see Figure 14.12).New theories suggest that neurog

48、enesis may play a central role in the regulation of mood and depression.Figure 14.12. The hippocampus and depression. This graphic shows the hippocampus in blue. The photo inset shows a brain dissected to reveal the hippocampus in both the right and left hemispheres. It has long been known that the

49、hippocampus plays a key role in memory, but its possible role in depression has only come to light in recent years. Research suggests that shrinkage of the hippocampal formation due to suppressed neurogenesis may be a key causal factor underlying depressive disorders. Mood Disorders, continued Etiol

50、ogy of mood disorders, continuedCognitive factorsSeligman (1974) proposes that depression is caused by “l(fā)earned helplessness, in which people become passive and “give up in times of difficulty.Learned helplessness is also related to a “pessimistic explanatory style in which people attribute setbacks

51、 to personal flaws.Mood Disorders, continued Etiology of mood disorders, continuedNolen-Hoeksema (1991, 2000) also asserts that those who ruminate about problems put themselves at risk for depression.Finally, depression may be caused by negative thinking, as shown in Lauren Alloys (1999) studies (se

52、e Figure 14.14).Figure 14.14. Negative thinking and prediction of depression. Alloy and colleagues (1999) measured the explanatory style of first-year college students and characterized them as being high risk or low risk for depression. This graph shows the percentage of these students who experien

53、ced major or minor episodes of depression over the next 2.5 years. As you can see, the high-risk students, who exhibited a negative thinking style, proved to be much more vulnerable to depression. (Data from Alloy et al., 1999)Mood Disorders, continued Etiology of mood disorders, continuedInterperso

54、nal rootsDepression has also been correlated with interpersonal factors, such as poor social skills.It is unclear what the direction of cause and effect is, with regard to this correlation.Precipitating stressThere is also a link between stress and the onset of mood disorders.Schizophrenic Disorders

55、LEARNING OBJECTIVESDescribe the prevalence and general symptoms of schizophrenia.Identify the subtypes of schizophrenia, and distinguish between positive and negative symptoms.Outline the course and outcome of schizophrenia.Schizophrenic Disorders, continuedLEARNING OBJECTIVES, continuedSummarize ho

56、w genetic vulnerability and neurochemical factors may contribute to the etiology of schizophrenia.Discuss evidence relating schizophrenia to structural abnormalities in the brain and neurodevelopmental insults to the brain.Analyze how expressed emotion and stress may contribute to schizophrenia.Schi

57、zophrenic Disorders, continued Schizophrenia literally means “split mind.Schizophrenic disorders “are a class of disorders marked by disturbances in thought that spill over to affect perceptual, social, and emotional processes.Prevalence is quite low, with only about 1% of the population suffering f

58、rom this class of disorders.Schizophrenia is a severe disorder that usually has an early onset and a poor prognosis.Schizophrenic Disorders, continued General symptomsIrrational thoughtDelusions “are false beliefs that are maintained even though they clearly are out of touch with reality.A common de

59、lusion is the belief that ones mind is being controlled by an external source.Delusions of grandeur are irrational beliefs that one is “extremely important or famous.Schizophrenic Disorders, continued General symptoms, continuedDeterioration of adaptive behavior(e.g., inability to function at work o

60、r home.)Distorted perceptionAuditory hallucinations “sensory perceptions that occur in the absence of a real external stimulus or that represent gross distortions of perceptual input are common symptoms.Disturbed emotion (either “flat affect or inappropriate emotions for a situation).Schizophrenic D