醫(yī)學(xué)心理學(xué)資料：psychological_disorders_1

1、Psychological DisordersMental disorderSection OneIntroducing Abnormal Psychology 1.Definition: What do we mean by mental disorder? 2. Explanation: How do we understand mental disorder?3. Classification: How do we distinguish between different mental disorders? 1.Definition of mental disorder 2. Abno

2、rmal psychology history 3. perspectives on mental disorder 4. Classification of mental disordersWhy study abnormal psychology?Abnormal behaviour is part of our common experienceLots of unanswered questions and complexitiesPreparation for future careersMental Health ProfessionalsClinical Psychologist

3、 (Ph.D., C. Psych.)Psychiatrist (M.D.)Psychiatric Social Worker (M.S.W.)PsychoanalystTherapistWhat is “abnormal”Psychological disorderA “harmful dysfunction” in which behavior is judged atypical, disturbing, maladaptive and unjustifiable. Are all atypical or strange behaviors abnormal? A man kisses

4、or marries another manA person is walking on the middle of a town square swaying back and forth and singing loudly.A man barking like a dog and crawling on the floor on his hands and kneesA man driving a nail through his handA woman building a shrine to her dead husband in a corner of her living roo

5、m and leaving food and gifts for him at the shrinedrinkingAnimal fearsIdentifying Abnormal Behavior: criterion for judgementHow can we judge a behavior normal or abnormal? 1. Experiential standard 2. Medical standard 3. Statistic standard4. Social standard 1. Experiential standardClinical Assessment

6、 of Psychological Disorders Doctors clinical experience & Patients subjective experience (personal suffering)Doctors clinical experience -clincial symptomsFocuses on unusual thoughts/emotions/behaviors believed to indicate maladjustmentSensory distortionsPhysical symptomsUnusual beliefsProblemsIt to

7、o dependent on doctors subjective experience For example:The Rosenhan ExperimentOn Being Sane In Insane Places.“ Rosenhans Fake Psychiatric Patient StudyPatients subjective experience (personal suffering) A person has a mental disorder if they experience personal distress.Problems:What about the per

8、son who abuses drugs or believes they are receiving messages from outer-space without experiencing distress?Can you believe yourself feeling about your mental health ?compare: anxiety disorders schizophreniaOther example: Medical students disease2. Medical standard(biomedical standard)Many psycholog

9、ical disorders are as biological disorders. Medical disorder -Abnormality exists when there is a physical disease.Functional Imaging Techniques of Brain Brain structure is imaged using anatomical Magnetic Resonance Imaging (aMRI) while brain physiology is imaged using Positron Emission Tomography (P

10、ET), ERP (Event Related Brain Potentials) ，Magnetic Resonance Spectroscopy (MRS) or functional MRI (fMRI). .ERP (Event Related Brain Potentials) MEG(magnetoencepahalograph)ADHDAttention Deficit Hyperactivity Disorder /Attention Deficit DisorderIn men who had ADHD, PET scans showed that they processe

11、d a memory task in visual areas in the occipital lobe of the brain, as indicated by the yellow spots in the left image. Non-ADHD men used the temporal and frontal lobes, shown at right.MRI(Magnetic resonance imaging)MRIS give detailed volumetric measurements of specific regions of the brain.NEURO SP

12、ECT SCAN ProblemsLimited： Organic psychosis3. Statistic standardInfrequency or averageAbnormal behavior is uncommon Mental measurementPersonality test MMPI, PEQ, 16PF, Big FiveIQ test WPPSI , StanfordBinet Mood test Anxiety test, depression testNeuropsychological test H.RClinical Test SCL-90 This st

13、andard suggests “normal” is average. But by this definition unusually happy or unusually clever people would be considered abnormal. 4. Social standard Abnormal behavior is inconsistent with cultural norms “Social norm ”A person has a mental disorder if they have experiences and exhibit behaviours t

14、hat are inconsistent with the norms and values of society.Examples:Behaviour that is harmful to oneself or othersPoor reality contactInappropriate emotional reactionsErratic behaviour Abnormal behavior is that a particular culture regards as troublesome or unacceptable. Its not according with the “S

15、ocial norm ” The difficulty is it does not clearly to tell us what behavior a society should accept.Cultural differences on views of abnormal behavior.Norms are not stable.Different cultural have different “norm ”Different time have different “norm ”HomosexualityAbsolute More Unmeant Both Unmeant Mo

16、re Absolute HET HET HET HOM HOM HOMHomosexuality A.agrees B.disagrees C.cannot reach a decision 1. Homosexuality is normal. 2. Having a homosexual friend or neighbor is OK by me. 3. Its OK for homosexuals to be teachers, including teachers of children.4. Families with homosexual parents should be po

17、rtrayed in some childrens books. 5. Homosexuals should be allowed in the military, including combat divisions. 6. Its OK for homosexuals to get legally married, and receive the legal benefits of being married. 7. Its OK for homosexual couples, or even single homosexuals, to raise children. 8. I woul

18、d vote for a homosexual who was running for president. 9. It would be OK by me if one or more of my children were homosexual. 10. It would be OK by me if I found out that my parent was homosexual. Why certain disorders occur in some cultures but not others?(1)the conditions necessary for causing the

19、m occur in some places but not others.(2)people learn certain kinds of abnormal behavior by imitation. eg. Anorexia nervosa modern industrialized societiesProblems:What if violation is result of external circumstancesSuch a criteria can seem too arbitrary and open to abuseThe ConsensusAll of the abo

20、ve definitions are incomplete we all have a definition in our heads, whether we can clearly state it or not .In short , there may be no simple way to define abnormal behavior or psychological disorder.Our lack of a clear definition is a problem in some cases and not in others. “Severely disorder” ma

21、y easier be distressed or disordered by everyone standard or definition. Overview of definitionsMental disorder as a statistical deviationMental disorder as dysfunctionMental disorder as personal discomfortMental disorder as maladaptive behaviourMental disorder as norm or value violationIn general,

22、behaviors that cause people to suffer distress and that prevent them from functioning in daily life are abnormal and should be the focus of research and intervention. Such behaviors are often described as maladaptive or dysfunctionalThe 3D Defining Maladaptivences or AbnormalityDSM-IV definition of

23、mental disorderA mental disorder is “conceptualized as a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an

24、important loss of freedom.”“The syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.”“It must currently be considered a manifestation of a behavioural, psychological, or biological dysfunction in the ind

25、ividual.”Multiple criteria are needed to diagnosis disordersCentral focus: clinically significant distress and/or dysfunctionRisk of death, pain, disability, loss of freedom, harm to othersHistorical Background of Abnormal psychologyThe Ancient AgeThe Middle AgeThe RenaissanceThe Age of Reason and E

26、nlightenmentThe Reform Movement (19th century )The Ancient Age Historical PerspectivesDemon or spirit possessionControlled by (or actually are) witches Criminal devianceCause of Psychological disorders : strange forces: the movement of stars, godlike powers, or evil spirits Treatment:cure might have

27、 been to get rid of the evil force: placating the great powers or exorcising the demon.“therapy”: beat, burn, castrate,pulling teeth, removing lengths of intestines, transfusion animal bloodThe Middle AgePeople in the Middle Ages regarded bizarre behavior as a sign that the disturbed person was poss

28、essed by a demon. To exorcise demon, priests resorted to prescribed religious rituals. In this medieval engraving, the insane are shown being led through a dance in an effort to improve their mental condition. This late-15th century painting shows Saint Catherine of Siena casting the devil of a poss

29、essed woman. The devil is seen fleeing from the womans head It shows a method for curing insanity.An insane mans head is held in an oven while demons and troublesome thoughts exit through the top of the oven.The Renaissance The renaissance was a period of increased humanism,curiosity about nature ,a

30、nd interest in scholarship. Many medical authorities devoted much time to investigating skin blemishes,which were believed to indicate points of contact with Satan.The idea of magical cures embodied in shamanism was evident in the popular therapy of removing stones from the head.It shows an operatio

31、n for removing stones from the head.The Age of Reason and Enlightenment Reason and the scientific method came to replace faith and dogma as ways of understanding the natural world during this age(17-18th century ). Some scientists suggested that psychological processes, though not directly observabl

32、e, are equal in importance to the material processes of natural world. In some degree psychological disorders were similar to physiological disorders. The Reform Movement The growth of a scientific attitude toward mental disorders was accepted step by step in the 19th century. Philippe Pinel had gre

33、at sympathy for the plight of deranged. He believed that the required humane care and treatment. He began to a reform movement lasting for more one century, from France, Europe, to America and other countries. His idea is widely accepted by both professional works and the public today.The reform mov

34、ementPhilippe PinelClifford Whittingham Beers(1876 1943) was the founder of the American mental hygiene movement.Beers was born inNew Haven,Connecticutto Ida and Robert Beers on March 30, 1876. He was one of five children, all of whom would suffer from psychological distress and would die in mental

35、institutions, including Beers himself (see Clifford W. Beers, Advocate for the Insane). He graduated from theSheffield Scientific SchoolatYalein 1897 In 1900, after suffering a mental breakdown, Beers was confined to an asylum for three years. After his recovery he wrote this biography, which arouse

36、d a storm of protest and public concern about care of people with mental illness. In the eyes of many the modern mental health movement can be traced to this publication.In 1909 Beers founded the National Committee for Mental Hygiene, now namedMental Health America, in order to continue the reform f

37、or the treatment of the mentally ill. He also started the Clifford Beers Clinic inNew Havenin 1913, the first outpatient mental health clinic in the United States. He was a leader in the field until his retirement in 1939. Perspectives on mental disordersHow do we understand mental disorder?Perspect

38、ives of mental disordersPerspectives on psychological disordersWhat are the five current perspectives? ( or approach)The biological perspectiveThe psychodynamic perspectiveThe behavioral perspectiveThe cognitive perspectiveThe humanistic perspective1.The biological perspectiveCause of Psychological

39、disorders :A psychological disorder is a symptom of an underlying physical disorder caused by a structural or biochemical abnormality in the brain, by genetic inheritance, or by infection. treatment:Diagnose and treat like any other physical disorderDrugs, electroconvulsive therapy, or psychosurgery

40、.2.The psychodynamic perspectiveSigmund FreudThe psychodynamic perspective: Originally proposed by Freud, the psychodynamic perspective maintains that psychological disorder stem from early childhood experiences and unresolved, unconscious conflicts, usually of a sexual or aggressive nature. The cau

41、se assumed by the psychodynamic approach also suggests the curepsychoanalysiswhich Freud developed to uncover and resolve such unconscious conflictsConscious and Unconscious Theories of personality Libido: Stages of psychosexual developmentAnxiety and Defense MechanismsSequedce2conflict stress anxie

42、ty defense symptomsAnxiety and Defense MechanismsWhen we are unsuccessful in resolving a conflict through normal constructive actions, we become anxious. Anxiety is considered both a symptom of conflict and a signal to use a defense mechanism. Defense mechanisms are psychological maneuvers by which

43、we distort reality in ways that will help us avoid conflicts and reduce anxiety. Stages of psychosexual developmentLibido1.oral stage (0-1): mouth, feeding ,fixation 2.anal stage (2-3): anus, toilet training, fixation 3.phallic stage (4-5): genitals, Oedipus complex4.latency stage (6 to puberty):non

44、e, outside ,social concerns5.genital stage (puberty on): genitals ,opposite sex Psychodynamic perspectiveCause of Psychological disorders :Psychological disorders stem from early childhood experiences and unresolved, unconscious conflicts, usually of a sexual or aggressive nature.and /or imbalance a

45、mong to id,ego, and superego. Treatment: Bring disturbing repressed material to consciousness and help patient work through unconscious conflictsPsychoanalysis3.The behavioral perspective “Give me a dozen health infants, well-formed, and my own specified world to bring them up in and I will guarante

46、e to take any one at random and train him to become any type of specialist I might select, doctor, lawyer,artist,merchant-chief, and yes, even beggarman and thief,regardless of his talents, penchants, tendencies, abilities,vocations, and race of his ancestors” (John B. Watson,1925) The learning pers

47、pective According learning perspective, psychological disorders are not symptoms of an underlying disorder, the behavioral symptoms and themselves the disorder.Get rid of symptoms(the abnormal behavior),and the problem is solved. Many abnormal behaviors are thought to be learned and sustained in the

48、 same way as any other behavior. According to this view, people who exhibit abnormal behavior either are victims of faulty learning or have failed to learn appropriable patterns of thinking and acting. Behavior therapists use learning principles to eliminate distressing behavior and to establish new

49、, more appropriate behavior in its place.Main kinds of learning Classical conditioning(stimulus generalization)Operant conditioning(reinforcement)Social learning(observational learning)Learning perspective（behavioral perspective）Cause of Psychological disorders:Abnormal thoughts, feelings, and behav

50、iors are learned and sustained like any other behaviors, or there is a failure to learn appropriate behaviors. Treatment: Use classical and operant conditioning and modeling to extinguish abnormal behaviorBehavior therapy, behavior modification4.The cognitive perspectiveAlbert Ellis Aaron Beck The c

51、ognitive perspective It suggests that faulty thinking or distorted perceptions can contribute to some types of psychological disorders. For example, negative thinking is intimately involved in depression and anxiety. Treatment consistent with this perspective is aimed at changing thinking and percep

52、tions, which presumably will lead to a change in behavior Cognitive perspectiveCause of Psychological disorders : Faulty and negative thinking can cause Psychological disorders Treatment: Chang faulty,irrational, and/or negative thinkingBecks cognitive therapy, Ellis rational-emotive therapy 5.The h

53、umanistic perspectiveAbraham Maslow Carl Rogers The humanistic perspective It views human nature is inherently and rational and as naturally moving toward self-actualization (the fulfillment of each persons potential). According to this view, psychological disorders result when a persons natural ten

54、dency toward self-actualization is blocked (Maslow, 1970; Rogers,1961). Remove the psychological blocks, and the person can move toward self-actualization. Needs HierarchyHumanistic perspectiveCause of Psychological disorders : Psychological disorders result from blocking of normal tendency toward s

55、elf-actualization Treatment: Increase self-acceptance and self-understanding; help patient become more innerdirectedClient-centered therapy, Gestalt therapyClassifying psychological disordersDSM-The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).A manual published by the American Psychiatric Association, which describes about 290 mental disorders and their symptoms.ICD-10 The International Statistical Clas